Alumni Association Banner 598 Alumni Directory Information Request
RequiredRequired Question(s)

Please complete the following information for inclusion in the Alumni Directory on the new website. We encourage submissions from all Alumni, even if you are not currently (or yet) practicing. Send us your current info; You will have the opportunity to update your listing in the future.



Required 1.

Last Name:





50 characters left.
Required 2.

First Name (and middle name or initial, if applicable):






50 characters left.
Required 3.

Your Full Professional Name (as you would like it to appear on the website):




50 characters left.
Required 4.

Degree(s), Title(s), Certifications, etc. to follow name (abbreviate, please - ex. MSOM, LAc, CMQ):








50 characters left.
Required 5.

Year Graduated from AIMC Berkeley/Meiji College:









50 characters left.
Required 6.

Name of Practice/Clinic #1. If not applicable, write N/A:












50 characters left.

Please enter the information for practice #1 as indicated below.




By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

Job Title:
Work Phone:
Email Address:
Address 1:
Address 2:
Postal Code:


If Your Practice is in California, Please Include the General Geographic Location:



San Francisco
East Bay
South Bay
North Bay
Sacramento Valley
Southern California & Central Coast
Northern California

Website url (if applicable):









50 characters left.
Required 10.

Name, Address & Geographical Information & Website url of Any Additional/Seconday Practices/Clinics You May Have. If none, write N/A.















350 characters left.

Please complete the following sections with brief descriptions about your areas of specialty, biography, and your current practice. Althought the fields will accommodate entries of up to 350 words, please try to limit each of your descriptions to 200 words or fewer. Submissions may be edited for consistency.



Areas of Specialty:













350 characters left.

Brief Biography:















350 characters left.

Brief Description About Your Current Practice:













350 characters left.

If you have a photo of yourself that you would like us to post on the website alongside your practitioner info, please send your photo in an attachment (jpg or png, please) to Erin A Olinick at Write "Alumni Directory Photo" in the subject field. For those of you who do not have a pic, but would like one, we will be taking photos on Alumni Appreciation Day (March 24). Thanks!