Friday, October 5, 2012
UAB Alumni House, 1301 10th Avenue South
Birmingham, Alabama  35205
6 to 7 pm:  Reception
7 to 9 pm:  Dinner Program

Business attire
Spouse or guest welcome
Please RSVP by September 28, 2012 (see below)

RSVP

Please print, complete, and FAX to 205 934-1564 or mail to:

UAB William J. Koopman Appreciation Dinner
FOT 1231, 1720 2nd Avenue South
Birmingham, AL  35294-3412

Online registration becomes active on September 1, 2012 at: www.uab.edu/koopmandinner

Name: _______________________________________________________
Company or Institution: _________________________________________
Address: _____________________________________________________
Phone: __________________ Email: ______________________________
_____Individual Tickets: #_____ X $75 = $___________________
_____Table for Eight Guests $600
___Regular Meal
___Gluten Free Meal
___Vegetarian Meal
Complementary wine served at dinner;  Cash bar available during reception
The non-deductible portion of each ticket is $35.00
No tickets will be mailed; admission is by door list.

Method of Payment

__ Check Payable to UAB  __Visa  __MasterCard  __Discover  __American Express

Name on card: __________________________________________________
Card number: ________________________________ Exp. Date: _________
Billing address: __________________________________________________
Signature: ______________________________________________________

Name of guests

1.______________________________                     5.________________________
2.______________________________                     6.________________________
3.______________________________                     7.________________________
4.______________________________                     8.________________________

Questions?  Call (205) 975-5659

Thank you for your support of UAB!

Contribute to the Koopman Professorship Fund

I wish to make a gift to the Dr. William J. Koopman Endowed Professorship Fund.

In the amount of: ___ $5,000   ___$1,000   ___$500   ___$250   ___Other

Total enclosed (check payable to UAB):  __________________

Send to:

UAB William J. Koopman Professorship Fund
FOT 1231, 1720 2nd Avenue South
Birmingham, AL  35294-3412

Contributions may be given online at:  medicine.uab.edu/rheum/71569

Click on:  Make gift in honor of Dr Koopman to the William J. Koopman Professorship Fund

Contribute to the Book of Remembrances for Dr. Koopman

Please send your notes or photos for the book of remembrances by September 21 to:

Karen Caton
UAB Division of Clinical Immunology and Rheumatology
1825 University Blvd., SHEL 178F
Birmingham, AL  35294-2182
Phone: (205) 934-9031 / Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

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