Southern Illinois University School of Medicine Office of Alumni Affairs

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Reunion Registration

If you aren't attending any events that require payment, please don't use this registration

Use this link if you don't have anything to pay for

Registration implies the consent of the registrant and adult guest(s) for the use of photographic images on the School of Medicine alumni web page and in Aspects magazine.

Enter participant name(s) as they should appear on name badges. 

Alumni Information
* Required Field      
First Name *
(for badge)
Last Name *
Maiden Name
(or name at time of graduation)
   
Class Year* Specialty
Mailing Address * City *
State / Province * Postal Code *
Home Phone*
area code, prefix, number
Preferred Email *
Business Phone
area code, prefix, number
Secondary Email
Cell Phone
area code, prefix, number
   
Spouse / Guest
Check one:  Spouse Guest    
Is your spouse/guest a SIU SOM Alumni?



   If so, what year?

If this year is also your spouse's / guest's SIU SOM reunion year, please make sure that they complete information for the Memory Book. They can do this anytime by submitting here: https://www.siumed.edu/alumni/biosketch.html

 
First Name
(for badge)
Last Name
(for badge)
Children
Are your children attending with you?
Yes No
 
If so, please tell us their name, birth dates (including years) and gender.

 

Children's Names

Date of Birth

Gender

 
 
 
 
 
 
Special Needs / Vegetarian Requests
Pursuant to the Americans with Disabilities Act, please advise if you or your guest(s) require special assistance to fully participate in reunion activities. Please communicate any food allergies, request vegetarian selections for any of the reunion events, or indicate special needs in the text box below. Please specify which guest has special needs.
 
Events
Friday, June 24
  Reception - Complimentary
  How many will attend?
  Adults & children 13 and up  
  Children 6-12?

  Children 0-5?  
  Of the children listed above, how many would like to:
  Play Games Children must be accompanied by an adult.
  Swim Children must be accompanied by an adult.
  Complimentary shuttle to / from Island Bay Yacht Club will be provided.
Shuttle will depart Wyndham Springfield City Centre Hotel between 6:10 - 7 p.m.
Return shuttles will operate from Island Bay Yacht Club at 8:45 p.m. and 9:00 p.m.
  Will you use the shuttle service? * Yes No
  If so, how many passengers?
 
Saturday, June 25
  Memory Lane Tour
  Will you be attending the walking tour of campus conducted by Dr. Jerry Kruse, Dean and Provost; Dr. Christopher McDowell ’05 and Dr. Jonathan dela Cruz ’06 and Student Ambassadors?
   
  Class of 1976
  Picnic at Carol Jean’s Fine Cuisine. Food and non-alcoholic drinks provided for $20 per person. BYOB 
 
  Number Attending Vegetarian Meals Requested  
Alumni, Adult Spouse/Guest
   
  Class of 1981
  Picnic at Lisa and Keith Wichterman's. Catered lunch provided for $20 per person.  Drinks provided by host.
 
  Number Attending Vegetarian Meals Requested  
Alumni, Adult Spouse/Guest, Children 13 and older
Children-Ages 6-12
Children-Ages 5 and younger
   
  Class of 1986
  Informal gathering at Arlington's. Order from casual fare menu and pay own expenses.
 
  Number Attending    
Alumni, Adult Spouse/Guest, Children 13 and older
Children-Ages 6-12
Children-Ages 5 and younger
   
  Class of 1991
  Picnic at Cara and Mark Vasconcelles'. Catered lunch provided for $10 per person.  Drinks provided by host.
 
  Number Attending Vegetarian Meals Requested  
Alumni, Adult Spouse/Guest, Children 13 and older
Children-Ages 6-12
Children-Ages 5 and younger
  Class of 1996
  Picnic at Nicole and Eric Sommer's. Catered lunch and non-alcoholic drinks provided for $12 adults and $6 children (ages 6-12). Children 5 and younger are free.  BYOB
 
  Number Attending Vegetarian Meals Requested  
Alumni, Adult Spouse/Guest, Children 13 and older ($12)
Children-Ages 6-12 ($6)
Children-Ages 5 and younger (free)
  Class of 2001
  To Be Determined
   
  Class of 2006
  Picnic at Marthe and Jonathan dela Cruz's. Catered lunch and non-alcoholic drinks provided for $12 adults and $6 children (ages 6-12). Children 5 and younger are free.
 
  Number Attending Vegetarian Meals Requested  
Alumni, Adult Spouse/Guest, Children 13 and older ($12)
Children-Ages 6-12 ($6)
Children-Ages 5 and younger (free)
  Saturday Evening Event - $50 per person
  Reunion Celebration - Enjoy an array of food stations and cocktails while mingling with classmates.
 
  Attending Vegetarian  
Alumni
Guest

If you wish to bring additional adult guests, please contact Cris Milliken or Joe Houston at alumniaffairs@siumed.edu or call 217-545-7800.
Questions

If you have any questions please enter here:

Memory Book Info
Please share your current practice / professional information:

(Maximum characters: 3500)
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Career Summary (include any leadership positions you hold or have held):

(Maximum characters: 3500)
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Most memorable medical school experience:

(Maximum characters: 3500)
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Most interesting/daring thing I’ve done since medical school:

(Maximum characters: 3500)
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Phone 217-545-7800
P.O. Box 19650
Springfield, IL 62794-9650
The mission of Southern Illinois University School of Medicine is to assist the people of central and southern Illinois in meeting their health care needs through education, patient care, research and service to the community.

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