Tell us about YOU!

First Name


Last Name


Maiden Name (if applicable)


Spouse's Name


Address


City


State, Zip Code


Email Address


Home Phone


Business Phone

Complete where applicable:

B.S.

Year Graduated:

Major:

University:

M.S.

Year Graduated

Major

University

Ph.D.

Year Graduated

Major

University

Current Job Title


Current Employer

Have you attended functions on campus since graduation? Yes     No

Please list the types of functions that you have attended, or might like to attend: (examples: South Campus Tailgate, Awards Lunch, Class Reunion, sporting events etc.)

Comments or Class Notes

Would you like to enter this information for Classnotes? Yes    No

Would you like to be added to the FACS Alumni email /mailing list? Yes    No

To reduce spam, please answer this question: What's ten plus one?

Thank you for your time!