School of Medicine Golden Jubilee

Registrant

First, we'll take your information. You are the main registrant. Anyone you bring with you are your "Guests" and you'll enter their names on the next page.

First Name: Required Field

Last Name: Required Field

Primary E-mail: Required Field

I plan to attend:

I plan to attend: Yes
No

Click all that apply:

Click all that apply: SOM Alumni
Faculty/Staff (current or former)
Friend/Community Member

If SOM alumni, list graduation year:

Dietary restrictions:

Sponsorships
Add the number one "1" in the box of your selection. Remember, all sponsorships come with a certain number of tickets or tables included. Click here if you need a reminder of sponsor benefits.
The cost of $175 per person for goods and services is not tax deductible.

Please note: the deadline to have your sponsor name listed in the printed program at the event is Noon on May 11, 2022.

Platinum Sponsor includes two tables = 20 tickets.

Platinum Sponsor:

Quantity:
$75,000.00

Gold Sponsor includes two tables = 20 tickets.

Gold Sponsor:

Quantity:
$50,000.00

Dimond includes two tables = 20 tickets.

Dimond:

Quantity:
$25,000.00

Silver includes one table = 10 tickets.

Silver:

Quantity:
$10,000.00

Bronze includes one table = 10 tickets.

Bronze:

Quantity:
$5,000.00

Table Sponsor includes one table = 10 tickets.

Table Sponsor:

Quantity:
$3,000.00

Benefactor includes two tickets.

Benefactor:

Quantity:
$1,000.00

Sponsors: If you chose a sponsorship above, tell us how you would like to be recognized on the event website. (The program's print deadline was Noon on 5/11/22.)

Tickets
If you prefer to purchase individual tickets rather than a sponsorship, or if you are a sponsor but need more tickets than the number that came with your sponsorship, enter the total number of tickets you wish to purchase into the appropriate box.

Individual Tickets
The cost of $175 per person for goods and services is not tax deductible.

Individual Tickets:

Quantity:
$350.00

Young Alumni Tickets
Young Alumni are those who have graduated the UMKC School of Medicine from 2012 - 2022.
There is no tax deduction for this level.

Young Alumni Ticket:

Quantity:
$150.00

Next Page - Enter Your Guest Names...