Emergency Contact Chemistry For Chemistry and Biochemistry Use Only. Emergency Contact Form Name(Required) First Last UWM Position(Required) Faculty Staff Graduate Student Undergraduate Researcher Volunteer Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name of Emergency Contact(Required) First Last This is person who will be contacted in the case of an emergency. Phone(Required)Relationship to you(Required) Spouse Parent Friend Roommate Other Name of Emergency Contact (secondary) First Last PhoneRelationship to you Spouse Parent Friend Roommate Other I agree that my information may be used within the Chemistry Department only.(Required) Yes