CREIGHTON UNIVERSITY SCHOOL OF PHARMACY CLASS OF 1980 25 - YEAR REUNION QUESTIONNAIRE

CLASSMATE INFORMATION We would like to collect some Photo/Bio information for the reunion website. Please complete the following questionnaire and add any other information you would like to share with your classmates.

YOUR NAME:

YOUR NICK NAME:

MAIDEN NAME:

HOME ADDRESS:

CITY:

ZIP CODE:

STATE:

PHONE # :

MAY WE LIST YOUR PHONE # ?

YES

NO

E-MAIL ADDRESS:

DATE PHARMACY DEGREE RECEIVED (month/year):

PLACE OF EMPLOYMENT:

EMPLOYMENT ADDRESS:

CITY:

ZIP CODE:

STATE:

WORK  PHONE #:

FAX # :

SPOUSE (SIGNIFICANT OTHER)  NAME/OCCUPATION:

CHILDREN NAMES:

AGE:

PET NAMES (dog,cat,etc.):

HOBBIES:

WHAT HAS HAPPENED TO YOU SINCE GRADUATION? (news to share such as marriage, awards, promotions, etc.)

PLEASE SEND JERRY SHAW YOUR CURRENT PICTURE AND YOUR FAMILY PICTURE (any size)