School Alumni Chapters


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  • Oglevee Invite Front
  • Registration Form

    First Name*
    Last Name*
    Street Address*
    City*
    State/Province*
    Zip/Postal Code*-
    Phone (Home)()-- ext.
    Phone (Business)()-- ext.
    Email*
    Class of*

    Register for each event below

      ($15 by April 2, $20 at the door)
    Recognition of Reunion Classes: 1965, 1975, 1985, 1995, 2005
    and Nursing Alumnus of the Year.
     
     

    If you plan to bring a guest, please fill out the information below:

    Guest First Name
    Guest Last Name
    Guest plans to attend:

    If you or your guest plan to attend lunch, please submit credit card information below:

    Total Number Attending Lunceon (@$15 each)*

    Total Number Attending Dinner (@$55 each)*
    Total Amount Charged:
    Card Holder Name*
    Card Type*
    Credit Card Number*
    Credit Card Expiration Date*
    Credit Card CVV Number*
    Located on the back of the card
       CVV

    Continuing Education Registration:

    Please register online at http://www.cvent.com/d/drqm42
    *CONTINUING EDUCATION CREDIT
    5.25 contact hours will be awarded for this nursing activity. ($45.00 fee for Non-UMMC/Non VA participants wishing to receive contact hours.)
    The University Of Mississippi Medical Center School Of Nursing is an approved provider of continuing nursing education by the Mississippi Nurses Foundation, Inc., an Accredited Approver by the American Nurses Credentialing Center’s Commission on Accreditation.

    Please list any accessibility resources (e.g. sign-language interpreters, wheelchair access, dietary, etc.) you or your guest may require during this event: 
    Parking/Special Needs:
    • All UMMC faculty and staff are expected to park in their designated UMMC parking area.
    • Non-UMMC attendee parking designation will be available online at http://www.umc.edu/alumni/ by March 26, including map/shuttle service information.
    • Disabilities Act: It is the policy of UMMC not to discriminate against any person on the basis of disabilities; if you feel you need services or auxiliary aids mentioned in this act in order to participate in this event, please contact the Alumni Office at 601-984-1115 or 800-844-5800.
    If you need additional assistance with registration, please contact the Alumni Office at (601) 984-1115 or (800) 844-5800.