CLASS OF 1965 REGISTRATION FORM

Reunion registration closes on Friday, May 22. Mail this form with your check, payable to Harvard
Medical School, to HMS Alumni Office, 401 Park Drive, Suite 22 West, Boston, MA 02215. If you wish to
pay by credit card, visit http://hms.harvard.edu/1965 to access the secure online registration site.
Questions? Contact Emma Hastings at 617-384-8520 or by email at [email protected].
CLASS OF 1965 REGISTRATION FORM
Please print clearly.
First Name or Nickname (to appear on nametag): ____________________________________________________________
Last Name (to appear on nametag): _____________________________________________________________________________
Last Name at Graduation (if different than above): ___________________________________________________________
Daytime Phone Number: ____________________________Email Address: _________________________________________
Home City: __________________________________________________________ Home State: _______________________________
HMS/HSDM Degree(s): ____________________________________HMS/HSDM Year(s): _____________________________
Guest First and Last Name (to appear on nametag): __________________________________________________________
If your guest is an HMS or HSDM graduate, please indicate their class year: ___________________________
If you have more than one guest, please list them on the last page.
I allow HMS/HSDM to: (If left blank, we will include your information.)
List my name, city, state, and email address in the printed Directory of Attendees
 Yes
 No
Add my name to the attendees list on the HMAA website
 Yes
 No
Please indicate any special access needs or dietary restrictions for you and your guest(s).
Requests will be applied to all Reunion events.
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
REGISTRATION FEE:
#
Attending
Per Registration
The registration fee covers alumna/us and all guests
x
Fee
=
Total
$90
$90
WEDNESDAY, MAY 27:
6 p.m.
$80
per person
Welcome Reception at Legal Sea Foods
Park Square
$
THURSDAY, MAY 28:
All-day Satellite Parking
Parking is available in the Museum of Fine
Arts, Boston Museum Road Garage (20
Museum Road), by advanced registration. Due
to construction in the HMS Quad Garage,
parking is NOT available on campus. Shuttle
buses will provide transportation to campus.
8:30 a.m.
Breakfast
9:30 a.m. – Noon (select one)
 Faculty Symposium
Discovery at HMS
 Class of 1990 25th Reunion Symposium
From “Great Expectorations” to Great Advances
Noon – 1:30 p.m. (select one)
 Lunch (tickets required)
 Lunch Seminar (tickets required)
Maximize Retirement Income and Preserve
Accumulated Wealth
Family, Finance, and Philanthropy
1:30 – 4 p.m.
Class of 1990 25th Reunion Symposium
From “Great Expectorations” to Great Advances
6 p.m.
Reunion Gala Reception and Dinner
Four Seasons Hotel Boston
Reception and class photo followed by a
private Class of 1965 dinner
(tickets required)
Pre-paid valet parking at Four Seasons
Pre-order 8 x 10 class photo (taken at Gala)
# of cars
$145
per person
$35
per car
$25
per photo
$
$
$
Page Sub-Total: $____________________
Page 2 of 5
HMS/HSDM REUNION: Class of 1965 Registration, 4/27/15
FRIDAY, MAY 29:
All-day Satellite Parking
Parking is available in the Museum of Fine
Arts, Boston Museum Road Garage (20
Museum Road), by advanced registration.
Due to construction in the HMS Quad Garage,
parking is NOT available on campus. Shuttle
buses will provide transportation to campus.
8:30 a.m.
Breakfast
9:30 – 10 a.m. (select one)
 Annual Business Meeting
Harvard Medical Alumni Association
 Annual Business Meeting
Harvard Dental Alumni Association
10:15 – 11:45 a.m. (select one)
 HMS Alumni Day Symposium
Drug Development: Can We Afford It?
 HSDM Alumni Day Symposium
Innovations in Dentistry
Noon – 12:30 p.m. (select one)
 HMS State of the School Address
Dean Jeffrey S. Flier, MD
 HSDM State of the School Address
Dean Bruce Donoff, DMD ’67, MD ’73
12:30 – 4 p.m.
Lunch and Class Discussion
(tickets required for lunch, afternoon snacks
provided during discussion)
2:30 – 4 p.m.
HSDM Remembrance Program for Gerald
Shklar, AM ’71, DDS
6:30 p.m.
Dinner at the home of Bruce Chabner
Newton
#
Attending
x
Fee
=
Total
# of cars
$125
per person
$
$30
per person
$
$60
per person
$
SATURDAY, MAY 30:
11:00 a.m.
Tour of the Art of Americas Wing
Museum of Fine Arts, Boston
12:30 p.m.
Lunch at Bravo Restaurant
Museum of Fine Arts, Boston
Page Sub-Total: $_______________________
Page 3 of 5
HMS/HSDM REUNION: Class of 1965 Registration, 4/27/15
#
Attending
x
Fee
=
Total
SATURDAY, MAY 30 (continued):
1:45 p.m.
Tour of the Isabella Stewart Gardner
Museum
6 p.m.
Dinner at the Union Club of Boston
$20
per person
$
$115
per person
$
$20
per person
$
$15
per person
$
$35
per person
$
FAMILY AND FRIENDS ACTIVITIES:
THURSDAY, MAY 28
1:15 – 3 p.m. (tickets required)
Fenway Park Tour with Trolley Service
Adult
Fenway Park Tour with Trolley Service
Child, ages 3-15
1:15 p.m.
Trolley Service to Shopping
Boston’s Back Bay
FAMILY AND FRIENDS ACTIVITIES:
FRIDAY, MAY 29
2:30 – 4 p.m. (tickets required)
Boston Duck Tour
Adult
Boston Duck Tour
Child, ages 4-15
Boston Duck Tour
Child, ages 0-3
GENERAL ADMISSION TICKETS:
Institute of Contemporary Arts/Boston
Museum of Fine Arts, Boston
New England Aquarium
OPTIONAL:
Reunion Report Voluntary Payment
Reunion Class Gift
$30
per person
$10
per person
$15
per ticket
$20
per ticket
$20
per ticket
$55
$
$
$
$
$
$
$
Page Sub-Total: $_______________________
Page 4 of 5
HMS/HSDM REUNION: Class of 1965 Registration, 4/27/15
TOTAL ENCLOSED (sum of all Page Sub-Totals) $ ____________________
Mail this form with your check, payable to Harvard Medical School, to HMS Alumni Office,
401 Park Drive, Suite 22 West, Boston, MA 02215.
Questions? Please contact Emma Hastings at (617) 384-8520 or by email at [email protected].
List additional guests from page one below.
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______________________________________________________________________________________________________________________
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Page 5 of 5
HMS/HSDM REUNION: Class of 1965 Registration, 4/27/15