JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Michigan Public Health Alumni Reception | Detroit Registration
Wednesday, June 10, 2020
Time & Location: To Be Announced
Hors d'oeuvres and drinks provided
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
I plan to attend the event on Wednesday, June 10th in Detroit, MI.
*
Yes
No
Required
First Name
*
Your answer
Last Name
*
Please include your full last name. If your last name has changed, please write "current name (previous name)." Example: Smith (Olsen)
Your answer
First name and Last name as you would like them to appear on name tag
*
Please feel free to include nicknames or abbreviations
Your answer
Affiliation
*
Alumnus
Student
Faculty / Staff
Community Partner/Affiliate
Other:
Required
Department / Program
*
Biostatistics
Environmental Health Sciences
Epidemioloy
Health Behavior and Health Education
Health Informatics
Health Management and Policy
Nutritional Sciences
Undergraduate Education
Other:
Required
Graduation Year(s)
If applicable - Provide degree(s) from SPH only. Example: M.P.H. '86 , Ph.D. '90
Your answer
Guest Name
If you are planning to invite a guest, please list their name below
Your answer
Please Do Not Post My Name in the List of Registrants
Do Not Post My Name
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of University of Michigan.
Report Abuse
Forms
