W.E. Upjohn Society
Annual Dinner

Name

Preferred Pronouns

Email Address

Meal Selection Meal Selection Salmon Chicken (Gluten-Free) Eggplant (Gluten-Free/Vegan)

Dietary Restrictions Please note any dietary restrictions you may have.

Guest Name (optional)

Guest Preferred Pronouns (optional)

Guest Meal Selection Guest Meal Selection Salmon Chicken (Gluten-Free) Eggplant (Gluten-Free/Vegan)

Guest Dietary Restrictions (optional) Please note any dietary restrictions your guest may have.

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