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DMS Class of 2012's White Coat Ceremony

Registration Form
On Saturday, October 4, 2008, Dartmouth Medical School will host a program to welcome the Class of 2012 to the profession of medicine. Students and three guests (e.g. parents, and/or partners) are invited to participate in this significant ceremony in which first year students will receive their white coats.

It is always a memorable experience for both students and those who witness the first ceremony on their journey to becoming doctors. Because of space restraints, we ask your cooperation in limiting your guest list to three. We appreciate your assistance in helping us to accommodate guests for each student.

To assist us with our planning, please identify each guest by filling out the information requested below. Please type carefully since this information will be used to create name tags. An invitation to this special event and to a reception, hosted by the Office of Alumni Relations, will be mailed to each guest in early August.

Entries marked with * are required.

Student's Name*:

Telephone #*:

Guest 1

First Guest's Name:

Address:

City:

State:

Zip Code:

Telephone:

Relationship to you
(and any special needs):

Guest 2

Second Guest's Name:

Address:

City:

State:

Zip Code:

Telephone:

Relationship to you
(and any special needs):

Guest 3

Third Guest's Name:

Address:

City:

State:

Zip Code:

Telephone:

Relationship to you
(and any special needs):

Please submit this form no later than July 18, 2008. If you have additional questions please call the Office of Alumni Relations at (603) 653-0741 or email Tracy.L.Pope@Dartmouth.edu.

Dartmouth-Hitchcock Medical Center • White River Junction VA • Norris Cotton Cancer Center • Dartmouth College

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