Michigan Public Health Alumni Reception | Chicago Registration
Tuesday, October 1, 2019 | 6-7:30 pm

Roanoke Restaurant
135 W. Madison St., Chicago, IL 60602
Madison Room (2nd Floor)
Email address *
I plan to attend the event on Tuesday, October 1 in Chicago, IL. *
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 *
Department / Program *
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
See who is coming; view the registration list here: https://sph.umich.edu/alumni/Chicago-registrants.html
Once you have registered, your name and graduation year will be visible in the next two business days. Thank you!
Please Do Not Post My Name in the List of Registrants
A copy of your responses will be emailed to the address you provided.
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