TUSPM Great Exchange Registration
Adding an Associate or Selling a Practice

Date:

Please select from the following options:
 I am looking for an associate or partner.
I am interested in selling a practice.
Include my information on the list of practices and positions available, to be shared with TUSPM graduates, and keep me informed of new seekers.
Do not include my information on the list of practices and positions available but use it to keep me informed of new seekers who may meet my needs.

First Name: Last Name: MI:
Street Address:
City:
State or Province:   Zip Code:
Office Phone: Home Phone: Fax:
Email address:

Podiatric medical school attended: Graduation year:
City and State of practice location:
Nearest major city (if applicable):

Please describe your position or practice as you would like it to appear on the TUSPM Great Exchange list of positions available and practices for sale:

If you prefer, fill out the form, print it and mail or fax to:
Mail:
Alumni Relations Office
TUSPM
8th and Race Streets
Philadelphia, PA 19107
Fax:
215-922-7830

If you have questions regarding this form, you may contact Dave Burt, Assistant Director of Development, at 215-625-5248 or email at great.exchange@temple.edu.

© Copyright 2008 Temple University. All Rights Reserved.