First Name:

Middle Initial:

Last Name:

Graduation Name:

UM Degree(s) and Graduation Year(s):

Home Address:

City:

State:

Country:

Zip/Postal Code:

Phone #:

Email Address:

Employer:

Job Title:

Ship me an Alumni Card

Yes
No

Yes
No

Professional and Social Networking
Recruitment of Students and Scholarship Fundraising
Ibis - Sports Related Events
Devotion to Community
Education for Alumni

President
President Elect/Vice President
Treasurer
Secretary