RUSM Alumni Ambassador Sign Up Form Question Title * 1. PERSONAL/CONTACT INFORMATION First Name: Middle Initial: Last Name: Last Name (if different at time of at time of graduation): Graduation Year: Preferred Phone Number: Preferred Email Address: Home Street Address 1: Home Street Address 2: Home City: Home State/Province: Home Zip Code: Home Country: Business Street Address 1: Business Street Address 2: Business City: Business State/Province: Business Zip Code: Business Country: Business Phone: Question Title * 2. I am interested in becoming an Alumni Ambassador for the following (select all that apply): Information Seminar/Webinar Panel Alumni Mentor Program On-Campus Specialty Panel White Coat Ceremony Speaker Commencement Speaker Prospective Student Outreach Clinical/Residency Representative Conference/College Fair Speaker Journey to Medicine Program Match Day Event Representative Regional Chapter Leader/Class Representative New Student Mixer Profile in Marketing Material Alumni Association Council Member New Student Orientation Ambassador Government Relations Ambassador Media Relations Ambassador None at this Time Done
