Alumni Board Membership Form

Thank you for serving on your school's Alumni Chapter Board of Directors. Please complete the following form and submit online. If you prefer a paper copy or having any questions, email alumni@umc.edu or call (601) 984-1115.

Alumni Board Membership Information

* = Required Fields

Board Member Full Name
Name in School (if different from above)
Preferred Name
Class Year
Employer/Practice Name
Title
Business Address
Business Phone	() - ext.
Cell Number	() -
Business Email
Home Address
Home Telephone	() -
Personal Email Address
Birthday Month/Day (Year optional)
Spouse Name
Names of any family members enrolled in/graduated from UMMC:
How do you prefer to be contacted? Check all that apply. Work Email Personal Email Work Phone Home Phone Cell Phone Text Message