SIU-SM Home | About SIU-SM | Directories | News/Information | SIU Carbondale | Search

SIU School of Medicine

arrow Home
Alumni Society
  - Distinguished Alumni Award
  - Class Agent
arrow Minority Alumni Caucus
Update Alumni Profile
Alumni Reunion Weekend
arrow Alumni HOSTS Program
Make a Gift
arrow Publications
Contact Us

Class Agent Form

Thank you for your interest in becoming a class agent. The following form can be used to contact us. Of course this information is kept confidential.

Mailing Address  
City State Zip  
Home Phone
area code, prefix, number
Work Phone
area code, prefix, number
FAX Number
area code, prefix, number
I will not be able to serve as Class Agent, but recommend the following person(s).
If you would rather send your information to us U.S. mail or fax please use this pdf file.


SIU SOM Home Alumni Home