I will be glad to host NYU School of Medicine fourth-year students during their visit to my city for a residency interview.
	Thank you, but I do not wish to participate in the Alumni Hospitality Program at this time.
Please take a minute to fill in the information below:
First Name		Last Name		Class Year
Office Address
City		State		Zip Code
Office Telephone			Email
Home Address
City		State		Zip Code
Home Phone		Home Fax		Home Email
Specialty			Spouse's Name
Accomplishments
Thank you for helping our students/future alumni! We appreciate your consideration and your time.