User to add/delete membership in public email groups:
* First Name     Last Name   Middle Initial

* User's E-mail ID

* Department   

Please list all public email groups this person should be added to:
Please enter one group name per line..

Please list all public email groups this person should be removed from:
Please enter one group name per line.

NOTE: YOU CAN FIND EMAIL PUBLIC GROUP NAMES IN THE GLOBAL ADDRESS BOOK IN YOUR OUTLOOK CLIENT. PLEASE ENTER THE PROPER GROUP NAME IN THE ABOVE BOXES.

* Signature of Requester:   
By entering your Name in the box labeled signature, you are digitally signing your name to this request.
Committee Chairs, department heads or manager must sign form.

* Phone number of Requester