We will be creating an MPH Class of
1992/Caribbean Alumni Directory.
Check this box to opt-out.
Baltimore, July 19-20, 2012
St. Lucia, July 30-August 2, 2012
Zip/Postal Code &
E mail address:
Occupation: __________________________ Employer: _____________________________________
I would like to attend:
Baltimore Reunion, July 19-20 ($75)
*Guest cost: $50 (children under 15 free) Name of guest(s): _____________________________
St. Lucia Reunion, July 30-August 2 (NO FEE)
*Guests pay on site Name of guest(s): _____________________________
Names of faculty with whom you would like to reconnect (Baltimore only):
Payment Information Total Amount enclosed / to be charged to card. $ _____________
My check/money order payment is enclosed. Checks/money orders are payable to The Johns Hopkins University.
I would like to pay by credit card.
Credit Card: DISCOVER _____ VISA _____ MASTERCARD _____
Cardholder’s Name __________________________________ Card No. ___________________________________
Cardholder’s Signature _______________________________ Expiration Date _____________________________
Cardholder’s Phone Number __________________________
Cardholder’s Billing Address _____________________________________________________________________
Mail or fax form to: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E2148, Baltimore, MD 21205.
Fax: (410) 614-2405. The deadline for registration is July 13, 2012 and no fees will be refunded.
Questions? Contact Philippa Moore, Director of Alumni Relations at 410-614-5019 or by e mail at firstname.lastname@example.org