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

 

 

 

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