NAME:

(W/ PRONUNCIATION AND NICKNAMES)

UNDERGRADUATE AND GRADUATE SCHOOLS(s)

ATTENDED:

DEGREE(s) EARNED:

(INCLUDING DEPT., CONCENTRATION, ETC)

HOMETOWN:

BIRTHDAY:

HOBBIES/INTERESTS:

INTERESTING/SHOCKING/WONDERFUL FACTS ABOUT YOURSELF:

***NOTE: WE’RE PLANNING AN ON-LINE VERSION OF THIS BOOK, SO IF YOU OBJECT TO HAVING YOUR FACE PLASTERED ON THE WEB, PLEASE LET US KNOW HERE:

Please return this form, INCLUDING A 2.5 x 3.5 PHOTO (application-sized),

in the envelope addressed to Jenny Kreisher. Deadline for submission is July 30.

Questions? Feel free to contact us: [email protected] or

[email protected].