Office of Development

The Khatali Medical Alumni Association

Keep in Touch

Let us know what you’re up to these days!
Responses will be shared on our website and in UNMed magazine.

First Name
Last Name
Middle Initial
Class year
Work Phone
Fax
Work Address
Home Phone
Home Address
E-mail
Where do you prefer to be contacted?
Where are you practicing now?
Type of practice
Area of speciality, subspeciality
Where did you complete your residency?
Year completed
Spouse's name
Is your spouse a UNM graduate?


If so, what department/college?		 yes no
Children names and ages
Grandchildren names and ages

List any honors or awards you’ve received recently

List any special projects or research you’re involved in

May we share this information with other alumni on our web site? yes no
May we list your e-mail on our web site? yes no
Would you like to receive information about:
School of Medicine research programs yes no
School of Medicine clinical care programs yes no
School of Medicine educational programs yes no
Endowments yes no
Planned Giving to the School of Medicine yes no
Other giving opportunities yes no
Would you like to be contacted by the school development officer? yes no
Additional comments or questions