Alumni Directory New Submission

All submissions are reviewed by database manager prior to directory
modification. Accepted submissions will show up in the next directory update.

Please give submitter's contact information (*required):
*Name:
*Phone (area code included):
Email:

Personal Information
Lastname:
Firstname:

Phone:
FAX:
Email:
Web URL:
Address:

City:
State:
ZIP:

ANR/CE Work Information Employee
Job Title:
Location of Work (county, campus):
Program Area:
Unit of Work:

Current Information
Status of Employee:	Retired Separated Deceased
Significant Other's First Name:
Significant Other’s Last Name:
Current Interests:
Current County of Residence:

Additional Information
Do you wish to be listed in the on line ANR Retiree Directory? (Click one) Yes No
Do you wish to receive email notification of future issues of the on line ANR Report? (Click one) Yes No

Picture:	Pictures may be submitted for use in the on line directory Mail picture to: ANR Retiree Directory 1111 Franklin Street, 6^th Floor Oakland, CA 94607-5200 (510) 987-0135 Email picture file to anrdevelopmentservices@ucop.edu.