Alumni Update and News Form

Please provide the following contact information below. At the end of the form is space to include notes of what is new in your life!

We appreciate you taking the time to keep us informed and up-to-date. Thank you!

Class of A value is required.Invalid format.
For reunion events, please include me with the class of   Invalid format.
Last Name A value is required.
First Name A value is required.     Middle Initial
Preferred Name
Marital Status Single    Married
Maiden name
(or other names) if used during medical school
E-mail A value is required.Invalid format.
Web Site (URL) Invalid format.
Specialty
Subspecialty No Yes   If Yes, please specify
  Is this a change in specialty (subspecialty) since medical school?
  No Yes 
Professional Information
Academic Title
Business Name or Institution
Office Address
City
State/Province
Zip Code Invalid format.
Country (If other than U.S.)
Office Phone
Office Fax
   
Confidential Information (for Office Use Only)
Home Address
City
State/Province
Zip Code Invalid format.
Country (if other than U.S.)
Home Phone
Home Fax
Cell Phone
   
Specify your contact preference
   E-mail
   Office Address
   Home Address
   Office Phone
   Home Phone
   Cell Phone
   
Send us a photograph of you and/or your family that can be included in one of our newsletters under "Class Notes."  There are three options for you to do this:

  1. The best way to send photos is via e-mail attachment. Please name the file with your first initial and last name (i.e., jsmith.jpg).

  2. If you have posted photos to a web site, send us the URL, just type in the web address in the following box:  

  3. You may also mail a hard copy of your pictures. Any professional photos such as those from Olan Mills, must be accompanied by written permission from the copyright holder. Photos will be scanned and then returned to you.
 

What's New with YOU?

Comments, Anecdotes, Additional Information about Yourself, Family, Children or Other Classmates. If you have a news release or other newsworthy item please include this for the newsletter.

 

May we publish your comments and photo on-line or in the next issue of College of Medicine Update?
 Yes   No
 
  

Alumni Affairs
PO Box 245018
Tucson, AZ 85724
Phone: 520.626-2827
FAX: 520.626-4884
Email: medalum@u.arizona.edu

© 2003 Arizona Board of Regents