CLASS OF 1966 REGISTRATION FORM

Size: px

Start display at page:

Download "CLASS OF 1966 REGISTRATION FORM"

Molly Fields
5 years ago
Views:

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 1966 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 WEDNESDAY, JUNE 1: 5:30 p.m. Cocktail Reception, as usual, at the home of Bill and Jensie Shipley 40 Dunster Road, Chestnut Hill, MA We hope you will attend the other HMS 50 th events, but if not, you need not register with HMS to be very welcome at our party. RSVP 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 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! 12:30 4:30 p.m. (tickets required) Class of 1966 Lunch, Symposium and Discussion of cars p.m. (tickets required) Reunion Gala Reception and Dinner Four Seasons Hotel Boston Reception and class photo followed by a private Class of 1966 dinner Pre-paid valet parking at Four Seasons Pre-order 8 10 class photo (taken at Gala) per car 25 per photo Page Sub-: Page 2 of 5 HMS/HSDM REUNION: Class of 1966 Early Registration, 3/31/16

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. (select one) Continental Breakfast Lobby, NRB Continental Breakfast Lobby, HSDM REB 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, select one) Lunch Atrium, TMEC Reception in Honor of Dr. Guralnick Lobby, HSDM REB 2 p.m. (select one) Tour of the new HMS Clinical Skills Center Tour of HSDM Campus of cars Page Sub-: Page 3 of 5 HMS/HSDM REUNION: Class of 1966 Early Registration, 3/31/16

4 FRIDAY, JUNE 3 CONTINUED: 4 p.m. Check-in at the Newcastle, NH Overnight reservations must be made directly with the Hotel. To make a reservation, please call and ask for the Harvard Medical School room rate. 5:30 p.m. (tickets required) Reception and Lobster Bake SATURDAY, JUNE 4: 2 p.m. Croquet Portsmouth Croquet Club, Portsmouth, NH 5:30 p.m. (tickets required) Reception and Dinner SUNDAY, JUNE 5: 11 a.m. Check-out 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 p.m. (tickets required) Boston Pops Concert Raiders of the Lost Ark (Front section) FAMILY AND FRIEND ACTIVITIES: FRIDAY, JUNE 3 2:15 4 p.m. (tickets required) Adult Child, ages 4-15 Child, ages Page Sub-: Page 4 of 5 HMS/HSDM REUNION: Class of 1966 Early Registration, 3/31/16

5 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) 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 1966 Early Registration, 3/31/16

CLASS OF 1966 REGISTRATION FORM

CLASS OF 1966 REGISTRATION FORM 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 02215. If you wish to pay