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Alumni Board Nomination Form

Thank you for your interest in serving on your school's Alumni Board. Please complete the form below and submit. If you prefer a paper copy or have any questions, email alumni@umc.edu or call (601) 984-1115.

Your Name *

Name of Board Nominee *

School *

Nominee Class Year

Nominee Employer/Practice Name

Nominee Cell Number *

Nominee Email Address *

Tell us why you're nominating this person (e.g. clinical service, research, education, and/or administrative leadership). *

Resume/CV