THE UNIVERSITY OF ILLINOIS AT CHICAGO
Memory Book Questionnaire
Please complete the following questionnaire, even if you are unable to attend the Pharmacy Alumni Weekend. Responses will be included in the reunion program booklet and also distributed to those who respond, but cannot attend. Please send electronic photographs via email to pharmacy@uic.edu or by postal mail to: Pharmacy Alumni Office UIC College of Pharmacy 833 S. Wood Street, MC 874 Chicago, IL 60612 Please clearly label all hard copy photographs with your name, class year and address on the back to ensure prompt return. Only submissions made on or BEFORE March 30th will be in the 2008 Memory Book.
1. Name:
2. Name while student, if different
3. Class year(s) and degree(s):
4. E-mail:
5. Current employer and title:
6. Education after graduation:
N/A
7. Professional experience:
N/A
8. Family life:
N/A
9. Other adventures:
N/A
10. My best memory of the College of Pharmacy is:
N/A
11. My favorite instructor/class was:
N/A
12. For me, the hardest part of college was:
N/A
13. As a student, I was a member of:
N/A
14. The last time I visited campus was:
N/A
Please select what contact information you would like displayed in the Memory Book. The Memory Book will be available to those attending reunion as well as those who respond to this questionnaire. To select multiple options, hold down the control key on your keyboard.
15. Please list my following information in the Memory Book:
question 15
My contact information as provided on the registration form.
My mailing address
My e-mail address
My phone number
Form Builder WebTool created by the Office of Web Services