2015 Alumni Weekend Memory Book Form

Even if you cannot attend, please complete this form and you will be sent a Memory Book after the Reunion.

Form must be submitted by April 17, 2015.
 

Please note that this form may time out after 20 minutes and your information may not be submitted.

If you need more than 20 minutes, please submit part of your information and then submit a second form with the rest. Please include your name and class on both forms. Thank you!

Fields that have arrows on the right side will scroll automatically as you type.  There is no need to limit your comments to the size of the box as displayed.

Name

Class of

HOME
 

Address

Telephone

E-mail (A copy of your responses will be sent to this address, if provided.)

WORK
 

Address

Telephone

E-mail

FAMILY
 

Spouse

Children (name/age/etc.)

CAREER
 

Career Info

LIFE/REFLECTIONS
 

Interests/Hobbies

Travel Highlights

Favorite Memory from Medical School

What Experiences have most changed your life since graduation?

Words of Wisdom

Additional Comments

Send a photo of yourself of you and your family.
Send an e-mail to alaluzerne@mcw.edu and attach a digital photo (JPEG preferred) or mail your photo to:

MCW Office of Alumni Relations
8701 Watertown Plank Road
Milwaukee, WI  53226

Please note: mailed photos will not be returned.

When you click Submit, you should receive a Thank You message as well as a copy of your responses at the e-mail address you entered in the Home E-mail field.

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
Directions & Maps
© 2015

Page Updated 01/14/2015
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