Name:

Gender:

E-mail:

Mailing Address:

City:

State:

Zip Code:

Telephone:

Year of Graduation:

Major:

Name at Graduation:

Occupation:

Employer

Marital Status:

What types of events or programs interest you?
Check all that apply:

At which specific area locations or attractions would you like to see an alumni event held?

Other ideas for alumni events?
Please list here:

What are the best days for you to attend an event?

What are the best times of the day
for you to attend an event?

Are you interested in serving as an Alumni Association Officer?

Would you be willing to help coordinate programs?

Are you a member of a club or organization through which you would be able to sponsor an event?

If yes, please specify

Other comments or suggestions