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Membership Form

(Print this form and send in)

First/Last Name:

  ______________________

Phone Number:

  (_____) _______________

Maiden Name:

  ______________________

E-mail Address:

  ______________________

Address:

  ______________________

Employer:

  ______________________

City/State/Zip:

  ______________________

Position Held:

  ______________________

Year of Graduation:

  ______________________

  Degree Received:

  ______________________

What kind of Alumni activities would be of interest to you?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Would you be willing to organize any alumni events?

_______  YES

_______  NO

The information you provide on this form will be kept confidential.  However, it would be helpful to be able to use your name and other pertinent information for the purpose of class reunions, class directories and alumni events.  Would you be willing to let us share this information with fellow ACC alumni for these purposes only?

_______  YES

_______  NO

Mail or fax this form to:  The Lumberjack Link, c/o Alpena Community College, 665 Johnson Street, Alpena, MI 49707-1495, 989.358.7553 (Fax)