| Tree Map | Print Version | Help
Summary| News| Events| Web Forms| Search
 
Medical Rehab. Home
 


 Indicates Required Field
 

Please update your profile by completing and submitting the following form. Your profile will be collected to produce future Homecoming presentations, similar to the one on display at our 50th Anniversary Homecoming Celebration.

With your consent, your profile will also be used to compile electronic Alumni Profile Albums that will be accessible on the SMR website. These albums will be in PDF format and will be password-protected; a password will be e-mailed to you once your profile has been received.

Your mailing address and your e-mail address will be used to update SMR records, as well as the Alumni Association's records; your addresses will not appear in any presentation or Profile Album.

 
First name:
 
Last name:
 
Enrolled name:
 
Mailing Address:
 
 
E-mail address:
 
Program:
 
Degree and graduating year:
 
Career highlights:
 
Currently, I...
 
Consent/Terms: By submitting this form to the School of Medical Rehabilitation, I consent to the use of my profile for display in future Homecoming
presentations, and for use in Alumni & Faculty Profile Albums that will be published on the SMR website.
 

Via separate email, please submit a current photograph(s) to Monique Berard at monique.berard@med.umanitoba.ca or mail to Monique Berard, School of Medical Rehabilitation, 771 McDermot Avenue, Winnipeg, MB R3E 0T6

Click on the Submit button below to send this form electronically. If you have indicated above that you consent to the use of this profile in future Homecoming presentations and in SMR's Alumni Profile Albums, we will e-mail you the password to access the Alumni Profile Albums.

For assistance or for more information, call Monique Berard at 204-480-1389.

Thank you for taking the time to update your profile!