1962 — 50th Reunion Celebration

The Class of 1962 Reunion Committee encourages all class members to complete the following survey for our 50th reunion booklet. Please take a few minutes to toot your own horn and share the interesting things you have been doing over the last 50 years.

* Required

First Name: *		Last Name: *
Nickname:		Maiden Name:
Birth Date:		Birthplace:

Street:

City:

State:

Zip:

Home Address:

Office Address:

Other Address:

Preferred Address:	Home Business Other

Preferred Phone Number:
E-mail Address: *
Medical Specialty:

I am currently	working
	retired

Recreational Activities and Hobbies:

Spouse/Partner:
Date Married:

Children (List names and ages):

Grandchildren (List names and ages):

I prefer to receive 50th reunion information by:

Postal Mail
E-mail

Tell us more. Please provide a free-flowing narrative in this section. Don't be shy!

Message to Classmates/Class:

Fondest/Funniest Memory From Medical School:

Of what are you most proud? Please comment on each of the following: personal accomplishments, professional accomplishments and family.

Please describe your activities: civic, charitable, scholarly and other.

Medical/Academic Positions, Awards, Honors:

Please feel free to share information or memories about other members of your class (updates, address/phone/e-mail information).

What do you believe are the five (5) most important advances in your field in the past 50 years?

What do you think are the three (3) most anticipated advances in your field in the next 50 years?

50th Reunion Commencement March — Sunday, May 13, 2012, 9:00 a.m., Kimmel Center

According to tradition, the School of Medicine commencement starts with a procession of administration, faculty and members of the 50th reunion class. It is a wonderful time for both students and alumni to reflect on their time as students and to look to the next steps in their careers.

Please complete the following information if you intend to march at commencement during Reunion Weekend

Guest Name:
So that we may order your robe for commencement, please provide the following information
Height:
Weight:
Hat Size:

Additional information is forthcoming, including registration information for Medical Alumni Weekend, programming and associated costs.

Reunion Update: The reunion committee encourages you to contribute photos for this year's booklet. Specifically, we would like retrospective photos dating from your time at Penn to the present in hopes of telling your story in the booklet. Please submit photos by February 14, 2012. If you would like to mail them, please label all photos with your name and address. Please mail photos to:

Penn Medicine Office of Development and Alumni Relations
3535 Market Street, Suite 750
Philadelphia, PA 19104

Alternatively, you can also upload images (photos) directly to our server. Click the "Browse" button, below, to find the image on your computer (in jpg, png or gif format only). Remember to follow the CAPTCHA instructions and click to submit this form.

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