University of the Sciences in Philadelphia

Alumni Form

Update Your Information, Submit a Class Note, Submit a Photo

Fill out and submit the form below to:

• Update your personal records
• Submit a Class Note with your latest news
• Submit photos for our Scrapbook
• Get added to our email list

Name (first, middle, last):
Reunion Class:
Birth Date:	(mm/dd/yyyy)
Street Address / Apartment #:
City:
State:	<<Please Select>> Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip:	-
Country:
Home Telephone:
Personal Telephone #2:
Email address:	Home      Business
Employer:
Title:
Business Address:
Business City:
Business State:
Business Zip:
Business Phone 1:
Business Phone 2:
Preferred Mailing Address:	Home      Business
Add a Class Note:
Photo:
Photo Information:
Are you a legacy?	Yes No
A Legacy is an alumnus or student in a family with one or more generations of graduates (living or deceased). This includes alumni and students who are related by marriage.
If "Yes", enter the name of your relative(s) . Be sure to include their relationship to you and their class year (if known)
Would you like to receive information and updates via email from time to time? Yes   No