CLASS OF 1971 REGISTRATION FORM

Transcription

1 Reunion registration closes on Friday, May 27. Mail this form with your check, payable to Harvard Medical School, to HMS Alumni Office, 401 Park Drive, Suite 22 West, Boston, MA If you wish to pay by credit card, visit to access the secure online registration link. You will need your HarvardKey to register online. Questions? Contact Emma Hastings at or by at Please print clearly. CLASS OF 1971 REGISTRATION FORM First Name or Nickname (to appear on nametag): Last Name (to appear on nametag): Last Name at Graduation (if different than above): Daytime Phone Number: Address: Home City: Home State: HMS/HSDM Degree(s): HMS/HSDM Year(s): Guest First and Last Name (to appear on nametag): If your guest is an HMS or HSDM graduate, please indicate their class year: If you have more than one guest, please list them on the last page. I allow HMS/HSDM to: (If left blank, we will include your information.) List my name, city, state, and address in the printed Directory of Attendees Yes No Add my name to the attendees list on the HMAA website Yes No Please indicate any mobility or access needs for you and/or your guest(s). Requests will be applied to all Reunion events. Please indicate any dietary restrictions for you and your guest(s). Requests will be applied to all Reunion events.

2 REGISTRATION FEE: Per Registration The registration fee covers alumna/us and all guests THURSDAY, JUNE 2: All-day Satellite Parking Parking is available in the Museum of Fine Arts, Boston Museum Road Garage (20 Museum Road), by advanced registration. Due to construction in the HMS Quad Garage, parking is NOT available on campus. Shuttle buses will provide transportation to campus. 8:30 9:30 a.m. Continental Breakfast 9:30 a.m. Noon (select one) Scientific Symposium HMS and Discovery: Award Winners Class of th Reunion Symposium- Part I From Faking It to Making It: Look Where the New Pathway Has Taken Us! Noon 1:30 p.m. (tickets required) Lunch Family, Finance, and Philanthropy Seminar with Lunch (please select only one) 1:30 4 p.m. Class of th Reunion Symposium Part II From Faking It to Making It: Look Where the New Pathway Has Taken Us! 6 p.m. (tickets required) Reunion Gala Reception and Dinner Four Seasons Hotel Boston Reception and class photo followed by a private Class of 1971 dinner Pre-paid valet parking at Four Seasons Pre-order 8 10 class photo (taken at Gala) of cars per car 25 per photo Page Sub : Page 2 of 5 HMS/HSDM REUNION: Class of 1971 Early Registration, 2/26/16

3 FRIDAY, JUNE 3: All-day Satellite Parking Parking is available in the Museum of Fine Arts, Boston Museum Road Garage (20 Museum Road), by advanced registration. Due to construction in the HMS Quad Garage, parking is NOT available on campus. Shuttle buses will provide transportation to campus. 8:30 9:30 a.m. Continental Breakfast 9:30 10 a.m. (select one) Annual Business Meeting Harvard Medical Alumni Association Annual Business Meeting Harvard Dental Alumni Association 10:15 11:45 a.m. (select one) HMS Alumni Day Symposium Medical Schools: Challenges and Opportunities HSDM Alumni Day Symposium A Tribute to Dr. Guralnick, DMD 41 Noon 12:30 p.m. (select one) HMS Dean s Address Dean Jeffrey S. Flier, MD HSDM State of the School Address Dean Bruce Donoff, DMD 67, MD 73 12:30 2 p.m. (tickets required) Lunch 2 3 p.m. (select one) Tour of the new HMS Clinical Skills Center Tour of HSDM Campus 3 4 p.m. Concert and Lecture: Music and Medicine: George Gershwin by Richard Kogan, MD 81 6 p.m. 10 p.m. Dinner and Sunset Cruise on the Odyssey Boarding time is at 6 p.m. Boat departs from Boston Harbor at 7 p.m. and docks at 10 p.m. of cars 130 Page Sub-: Page 3 of 5 HMS/HSDM REUNION: Class of 1971 Early Registration, 2/26/16

4 SATURDAY, JUNE 4: 2:15 4 p.m. (tickets required) Boston Duck Tour Adult Child, ages 4-15 Child, ages 0-3 6:30 p.m. Reception at The Liberty Hotel Bar Boston, MA FAMILY AND FRIEND ACTIVITIES: THURSDAY, JUNE 2 1:30 p.m. Trolley Service to Shopping Boston s Back Bay 2 p.m. (tickets required) Fenway Park Tour Adult Fenway Park Tour Child, ages GENERAL ADMISSION TICKETS: Institute of Contemporary Arts/Boston 15 Museum of Fine Arts, Boston 25 New England Aquarium 25 OPTIONAL: Reunion Report Voluntary Payment 55 Reunion Class Gift Page Sub-: TOTAL ENCLOSED (sum of all Page Sub-s) Page 4 of 5 HMS/HSDM REUNION: Class of 1971 Early Registration, 2/26/16

5 Mail this form with your check, payable to Harvard Medical School, to HMS Alumni Office, 401 Park Drive, Suite 22 West, Boston, MA Questions? Please contact Emma Hastings at (617) or by at List additional guests from page one below. Page 5 of 5 HMS/HSDM REUNION: Class of 1971 Early Registration, 2/26/16