Mu Nu Chapter
25th Anniversary Celebration
November 3-5, 2000
Data Form
Name___________________________________________
Address________________________________________
___________________________________________
___________________________________________
Telephone Number(s)__________________________________(home)
__________________________________(work)
E-mail_______________________________________________
Year of Graduation and Degree(s) USM:
______________________________________________________
______________________________________________________
______________________________________________________
Additional Education:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Date of Initiation at Mu Nu Chapter_____________________
Line Name
__________________________________
Individual Line Name
___________________________________
Place of Employment
________________________________________________________
________________________________________________________
Graduate Chapter Affiliation
________________________________________________________
Achievements Since Graduation( Organizations, etc..)
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Honors and Awards
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Family History
Spouse______________________________
Children________________________________________________
_________________________________________________________
Return Form To:
Denise Griffin
1049 Matthews Avenue
Jackson, Mississippi 39209