KUMC Alumni Update / Class Notes Form

Share your news with your classmates or just keep us up to speed on what you've been up to since graduation! Please fill in as much pertinent information as possible.

Please Note the following: Fields marked with * are required to submit this form.

Please use this information to update the alumni database ONLY. I do not want this information printed in Classnotes.

Please use this information to update the alumni database AND include it in Classnotes.

You

First Name: Middle: * Last Name:

Maiden Name: New Married Name:

*Graduation Year: Preferred Year (if applicable):

Spouse

First Name: Middle: Last Name:

If your spouse is an KUMC graduate, please enter their graduation year:

Children

New Birth - Child's Name: Birth Date:
New Birth - Child's Name: Birth Date:

Additional Child: Birth Date:
Additional Child: Birth Date:
Additional Child: Birth Date:
Additional Child: Birth Date:

please check this box if this is a new address or a change of address

* Street Address: Apt. or Suite Number:

* City: * State: * Country:
* Zip/Postal code:

* Home Phone: Home Fax:

* Home Email:

please check this box if this is information is new or changed

Occupation: Title:

Business Name:

Business Address:

City: State: Zipcode:

Business Phone: Your Extension (if any):

Business Fax: Business Email: