2008 Fall Alumni Reunion/CME Weekend Form

Items in red are required.

First Name:  
Last Name:  
Credential:  
Organization:  
Street Address:  
City:  
State/Province:  
Zip Code:  
Email Address:  
Home Phone:  
Work Phone:  
Cell Phone:  
Fax Number:  
 

For DOs Only

AOA#:

School:

Graduation Year:

 
Fees
UNECOM Alumni: Join the Association now and receive a discount on the Registration Fee (Alumni dues: $50/year, $125/3yrs, $500/lifetime)
General ($279 thru 8/29; $299 after 8/29)
UNECOM Alumni Assoc. Member ($250 thru 8/29; $275 after 8/29)
UNECOM Alumni Non-Member ($265 thru 8/29; $289 after 8/29)
Couple ($475)
Retired ($220)
Resident/Intern ($150)
Medical Student (Free; please register in advance)
 
Do you plan to attend the UNECOM Founders Reception & Dinner Friday Evening at 5:15 p.m.?  
If Yes, how many people?
 
Do you plan to attend the Alumni Association Luncheon Meeting Friday at 12:30-2:00 p.m.? (Additional $5.00 per person)   
If Yes, how many people?
To arrange payment by credit card please call (207) 602-2589 or send a check (payable to UNE) to: Continuing Medical Education, University of New England, 11 Hills Beach Road, Biddeford, ME 04005
Payment Method:  
   
       

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