Pharmacy Alumni Address Update Form

Have you changed jobs recently? Been promoted or relocated? Received any awards? Please let us know so that you may continue to receive our alumni magazine, the UIC Pharmacist, college newsletters, and other publications. We are also interested in hearing about your accomplishments and news.

If you do not wish to register online, you may submit the following form by mail or fax. If you have any questions or wish to speak with a member of our office, please call 312-996-0160.

Your Privacy: All information is kept strictly confidential.

ABOUT YOU

Please enter your information below.

1. Your Full Legal Name

2. Former/Maiden Name (if applicable)

3. Spouse's Name (if applicable)

4. Is your spouse an alumnus?

Yes

5. Additional Degree(s) Earned; please also note the University or College of Attendance.

HOME INFORMATION

6. Street Address

7. City

8. State

9. Zip Code answer must be a zipcode like 61864 or 61864-8180

10. Phone answer must be phone number with area code like 217-333-1000

11. E-mail answer must be an email address

EMPLOYMENT INFORMATION

Please enter your information below.

12. Title

13. Employer

14. Street

15. City

16. State

17. Zip Code answer must be a zipcode like 61864 or 61864-8180

18. Phone answer must be phone number with area code like 217-333-1000

19. E-mail answer must be an email address

Interesting/Exciting News

20. If applicable, please enter your information below. If appropriate, we will post this for fellow alumni and friends to see in our next alumni magazine.

VOLUNTEER INTERESTS

21. Select, if you are willing to:

serve as a Preceptor

provide career advice

serve in a networking capacity

assist with admissions interviews

serve on the Alumni Board

Thank you for helping us to keep in touch with you.