IU School of Medicine Alumni Association

Memory Books

The class Memory Book is a compilation of alumni updates from your class that will be distributed to your class during or after Reunion Weekend. Even if you are unable to attend the reunion, please provide a brief update. Your classmates will enjoy reading about what you’ve been up to.

Please complete this form, omitting or adding information as you please, regardless of whether or not you plan to attend the reunion. If you’d like to include a picture of yourself, your family, or something fun you’re doing, please do so at the end of the form. (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.)

Field marked with * are required.

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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