Techsan Memorial Name Addition Notification

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1. First Name of person to be included in the Techsan Memorial (Required.)

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2. Middle Name (if applicable)

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3. Last Name (Required.)

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4. Phonetic Pronunciation of Name (Required.)

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5. Date of Passing (Required.)

MM/DD/YYYY

Date

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6. Obituary Link (if available)

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7. University status at time of passing (Required.)

Current Student

Current Staff member

Current Faculty member

Retired Staff member

Retired Faculty member

Alumni

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8. University affiliation (College, school, dept.)

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9. Notifier Contact Information (Required.)

Name *

Email Address *

Phone Number

Techsan Memorial Name Addition Notification

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* 1. First Name of person to be included in the Techsan Memorial (Required.)

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* 2. Middle Name (if applicable)

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* 3. Last Name (Required.)

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* 4. Phonetic Pronunciation of Name (Required.)

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* 5. Date of Passing (Required.)

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* 6. Obituary Link (if available)

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* 7. University status at time of passing (Required.)

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* 8. University affiliation (College, school, dept.)

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* 9. Notifier Contact Information (Required.)

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* 10. Notifier Relationship (Required.)

1. First Name of person to be included in the Techsan Memorial (Required.)

2. Middle Name (if applicable)

3. Last Name (Required.)

4. Phonetic Pronunciation of Name (Required.)

5. Date of Passing (Required.)

6. Obituary Link (if available)

7. University status at time of passing (Required.)

8. University affiliation (College, school, dept.)

9. Notifier Contact Information (Required.)

10. Notifier Relationship (Required.)