Alumni Association

Alumni Contact Interest Survey

Your Contact Information

Name

Street Address

City, State and ZIP Code

Phone Number

E-mail Address

May We Publish Your Contact Information on the Web?

Yes No

Telephone Information

Daytime Telephone

Ok to put daytime telephone information on the web?

Yes No

Degree Information

Grad year(s) from WMU

Degree Received

Campus Involvement

Employment Information

Current Occupation

Current Employer

Why do you want to serve as an alumni contact?

Yes, I have read the information about alumni contacts and am willing to accept the responsibility required.