Leslie Dan Faculty of Pharmacy Alumni Update Form {1} ##LOC[OK]## {1} ##LOC[OK]## ##LOC[Cancel]## {1} ##LOC[OK]## ##LOC[Cancel]## Leslie Dan Faculty of Pharmacy Alumni Update Form There are a lot of great things happening at the Leslie Dan Faculty of Pharmacy and we want to make sure you are kept up to date! If you have moved recently or have a different email address you would like us to use, please let us know by filling out the following alumni update form. You can also provide feedback on events you would like to see, how you would like to get involved with your alma mater, and even any new professional updates you would like us to know. Know an alumni friend who is not receiving our Faculty updates? Send this to them too! First name: "First name" is required. Last name: "Last name" is required. Non - U of T Email Address Email address: ";Email address" is required. Confirm email: ";Email address:" confirmed text is required. Emails do not match! ";Email address"needs to contain a valid entry. Your password must have each of the above components and be at least 12 characters. Does Not Pass Low Moderate Secure Very Secure Re-type your password. Re-type your email. Please verify your input by typing it again. Passwords do not match! Emails do not match! Inputs do not match! Passwords match! Emails match! Inputs match! Employer: Job Title: Home Address 1: Home Address 2: Home City: "Home City" is required. Home Province or State: Not applicable Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nunavut Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Postal Code or Zip: Grad Year College (i.e. Pharmacy, UTSC, UofT): Degree (i.e. PharmD, BScPhm, BSc, BA): Any other degrees? (i.e. 2010 MA UofT): Do you receive the Rxcellence alumni e-Newsletter? Do you receive the Rxcellence alumni e-Newsletter? YesNo "Do you receive the Rxcellence alumni e-Newsletter?" is required. Please click off what you would be interested in: Please click off what you would be interested in: Mentor a student 1 on 1 (PharmaSEE program)Single evening menorship (e.g. Speed Mentorship)Be a speaker presenter or panelistBecoming a preceptorOrganizing a class reunionSupporting the faculty through a donationOther If you chose other, please list what you would be interested in: What events would you be interested in attending: What events would you be interested in attending: Academic LecturesProfessional Development LecturesSocial reunion eventsOther If you chose other, list events you would be interested in attending: Please Wait...
