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Stay Connected - Stay Informed

Fill out the form below and click "Send Now"

or contact:

Phyllis Itzkowitz

(516) 565-5640 ext. 232 

pitzkowitz@hanc.org  

 

 



Items denoted with a red asterisk * are required.
 * NAME
 
First Name
M.
Last Name
Maiden Name
 
 
 
YEAR Of GRADUATION
Elementary School
 
Jr. High School
 
High School
 
 
 
DEGREE INFORMATION
College, Graduate and Postgraduate Degrees
 
 
 
PERSONAL INFORMATION
Spouse Name
 
First Name
M.
Last Name
Permanent Address
 
Address 1
Address 2
City
State
Zip Code
Temporary (School) Address
 
Address 1
Address 2
City
State
Zip Code
Phone
 
 -  - 
(XXX)-XXX-XXXX
E-Mail Address
 
 
 
BUSINESS INFORMATION
Profession
 
Business Name
 
Title
 
Business Phone
 
 -  - 
(XXX)-XXX-XXXX
Business E-Mail
 
Business Fax
 
 -  - 
(XXX)-XXX-XXXX
Professional Affiliations
 
 
 
Information you would like to share with your alumni classmates: