School of Dentistry

Dental Alumni and Friends

DAF 2018 invitation

Please join us for Dental Alumni and Friends! 

Friday, February 9, 2018
6 pm
Fairview Inn, Jackson
$50 per person 

Please register by Friday, February 2. Contact the Office of Alumni Affairs at 601.984.1115 or alumni@umc.edu with any questions. 

 

Alumni Registration Form

First Name* 
Last Name* 
Street Address* 
City/State/Zip*:  - 
Phone (Home)() - x
Phone (Business)() - x
Email* 
Class of

Friday, February 9, 2018

Dental Alumni and Friends Dinner - Fairview Inn
6:00 p.m.

  • Guest First Name:
  • Guest Last Name:
Total number (yourself plus an optional guest) who will attend the dinner:
  (@ $50 each)
Please list any accessibility resources (e.g. dietary, sign-language interpreters,
wheelchair access, etc.) you or your guest(s) may require during this event:

Credit Card Information

Total amount to be billed:

Please pay with 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