NICKNAME: B.D.
HOME ADDRESS: P.O. Box 3356
CITY: Flagstaff
STATE: AZ ZIP CODE: 86003
PHONE NO.: ( )
E-MAIL ADDRESS: [email protected]
DATE PHARMACY DEGREE RECEIVED: May, 1980
PLACE OF EMPLOYMENT:
PLACE OF EMPLOYMENT PHONE NUMBER:
PLACE OF EMPLOYMENT FAX NUMBER:
PLACE OF EMPLOYMENT ADDRESS:
CITY:
STATE: ZIP CODE:
SPOUSE'S (SIGNIFICANT OTHER) NAME/OCCUPATION:
CHILDREN NAMES: AGE:
PET NAMES:
HOBBIES:
WHAT HAS HAPPENED TO YOU SINCE GRADUATION?
**** Please email Jerry Shaw if any of this information ****
needs to be updated
Date information entered: 8-10-2003