Name

Address

City

State

Zip

Okay to put address information on the web?

Daytime Telephone

Okay to put daytime telephone information on the web?

E-mail address:

Okay to put e-mail address on the web?

Grad year(s) from EMU:

Degree(s) received from EMU:

Campus involvement:

Current Occupation:

Current Employer:

Why do you want to serve as an alumni contact?