School Alumni Chapters

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  • MSMA Alumni Chapter Reception/Dinner

    August 17, 2013

  • To assure availability, please register by May 20, 2014.

    First Name*
    Last Name*
    City, State, Zip Code*
    Home Phone()--
    Bus. Phone()-- ext.
    Cell Phone()--
    Hotel/Condo at MSMA
    Enjoy a sunset cruise with family and UMMC alumni and friends as you relax with appetizers, beverages, and possible dolphin sightings over the crystal blue waters of Destin Bay.
    I will attend the Medical Alumni Chapter dinner/cruise.
    Adults (18 years or older):
    Youth (12-17 years of age):
    Children under 12 years of age:
    @$25 per person =
    @ $10 per person =
    - FREE
    Spouse/Guest Name
    Child(ren)'s Name(s)
    Billing Information
    Total Amount Billed:

    Credit Card Information

    Please use Visa or Mastercard only.
    Card Holder Name*
    Card Type*
    Credit Card Number*
    Credit Card Expiration Date*
    Credit Card CVV Number*
    Located on the back of the card