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MEMBERSHIP RENEWAL
Please check box below indicating appropriate fee category.  Make check payable to: SCHOOL OF DENTISTRY ALUMNI ASSN
 
Dentists             Hygienists
( ) $75.00           ( ) $50.00        DDS, MS and DH, MSDH Alumni
( ) $18.00           ( ) $13.00        Alumni now in graduate school programs
( ) $75.00           ( ) $50.00        Associate Members (graduates of other schools)
( ) $1125.00       ( ) $750.00      Life Membership (May be paid over 3 consecutive years: $375/yr DDS; $250/yr DH, MSDH)
                     

                          Class Year: _________
 
                          E-mail Address: _____________________________________________________              
                    
                          Name:    _____________________________________________________________
 
                          Address: _____________________________________________________________
 
                                          _____________________________________________________________
 
 
 
 
 
I would like to make a donation to the alumni association in the amount of ___________________
 
Please make check payable to:
School of Dentistry Alumni Association
 
Thank you for your support!

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