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The purpose of this questionnaire is to obtain an overall picture of our class to present in the form of a "memory book" after the reunion weekend on May 17th, 2008. The memory books will be mailed out 4-6 weeks after the reunion to those who order them. Please complete this form, omitting or adding information as you please, regardless of whether or not you plan to attend the reunion. (Please be aware that some or all of this information could be published in an article on the weekend and its participants. If this is the case, you will be contacted to receive permission and to verify any statements.)

Please complete this form by May 2nd, 2008.

Your IP Address:
First Name:
Last Name:
Maiden Name (if applicable):
Nickname:
Class Year:
Specialty:
Address 1:
Address 2:
City:
State:
Zip code:
Home Phone:
E-mail:
Are you planning to attend Reunion Weekend?	Yes	No	Maybe
Business Address 1:
Business Address 2:
City:
State:
Zip code:
Business Phone:
Spouse's Name:
Your class wants to know:
Children (names, ages, occupations)?
Personal interests, activities, hobbies?
Recent awards accomplishments, promotions?
What have been the highlights of your personal and professional life in the past five years?
Best med School Memory?
Favorite Faculty Member(s)?
If you are unable to attend the reunion this year, please write a message to your classmates below:

 

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Please contact the alumni office at (317) 274–8828, 866–267–3104 (toll free), or via e-mail at mchallib@iupui.edu.