Michigan Public Health Alumni Reception | Ann Arbor Registration
Thursday, May 7, 2020
5:30-7:00 pm

Zingerman's Greyline
100 N. Ashley St.
Ann Arbor, MI 48104

Hors d'oeuvres and drinks provided.
Sign in to Google to save your progress. Learn more
Email *
I plan to attend the event on Thursday, May 7 in Ann Arbor, MI. *
Required
First Name *
Last Name *
Please include your full last name. If your last name has changed, please write "current name (previous name)." Example: Smith (Olsen)
First name and Last name as you would like them to appear on name tag *
Please feel free to include nicknames or abbreviations
Affiliation *
Required
Department / Program *
Required
Graduation Year(s)
If applicable - Provide degree(s) from SPH only. Example: M.P.H. '86 , Ph.D. '90
Guest Name
If you are planning to invite a guest, please list their name below
Please Do Not Post My Name in the List of Registrants
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of University of Michigan. Report Abuse