Reservation Form

UNMC Alumni Gathering
Tuesday, May 13, 2008
Online Reservation

Please provide the following information: ( * indicates required information )

Personal Information

	* First Name:
	* Last Name:
	Address:
	City:
	State:
	Zip:
	Phone:
	* Email Address:

Select Your College:

Class Year:

2008 Blast at the Blatt

Indicate total number attending and guest's name(s)

Alumni Association Members/Guests:

$25 per person

* If not a member and you would like to join, complete portion below

Alumni Association Non-members/Guests:

$30 per person

UNMC Students/Guests:

$20 per person

Guest Name(s):

Children 3-10 years(2 and under are free and will have to sit on adult's lap):

$10 per child

Guest Name(s):

* Alumni Annual Membership

Medicine Alumni Annual Member - $65 Nursing Alumni Annual Member - $40
Pharmacy Alumni Annual Member - $35 Physical Therapy Alumni Annual Member - $45
Physician Assistant Alumni Member - $50

Press submit to be directed to a secured payment site. Alumni Affairs will confirm your Blast at the Blatt reservations in a separate email. This will include further instructions about obtaining your game tickets and attending the picnic. Thank you!