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Overview Upcoming Reunions Reunion Highlights		My Reunion Updates

Biographical Information

Name:

Name First Required	Name Middle	Name Last Required	Name Suffix

Email:

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Country:

Phone Number:

*Class Year

Maiden name or name used in medical school (if different from above):

Office Address

Office Name:

Street:

City:

State:

Zip:

Phone:

E-mail:

Medical Specialty:

Residency & Fellowship:

(Maximum response 255 chars, approx. 5 rows of text)

Practice situation:
Solo
Specialty Group
Multi-specialty Group
HMO
Academic
Other

If Academic, list institution:

Status:
married
single
partnership
divorced
separated

Life Partner Name:

Life Partner Occupation:

Children (names & ages):

(Maximum response 255 chars, approx. 5 rows of text)

What are their activities?

(Maximum response 255 chars, approx. 5 rows of text)

What are your hobbies?

(Maximum response 255 chars, approx. 5 rows of text)

Business interests?

(Maximum response 255 chars, approx. 5 rows of text)

Special interests?

(Maximum response 255 chars, approx. 5 rows of text)

What was your favorite class in medical school?

What was your least favorite class?

Do you have any special memories from medical school?

Who was your favorite professor and why?

How does your current reality compare to your expectations in the year you graduated?

Tell us your favorite County Hospital story:

Please provide any added facts, thoughts or feelings you wish to share with your classmates. These may include notes about your children and their children; the twists and turns of your career; reflections on the current state of medical care and it's impact on your career; the nature of your practice or retirement; major life trials and tribulations; remembrances of medical school; your golf handicap; your bad back; whether or not you'd "do it all over again;" fulfilled and unfulfilled hopes and dreams.