Alumni & Friends Membership Form

Membership Form
Name*

First NameLast Name
Date of Birth:*
Maiden/Birth Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:*
example@example.com
Campus Attended:
Major(s) / Program:
AAASAASCertificateNone
Year of Graduation:
Occupation:
Hobbies:
YesNo
YesNo
News to share: family, career, interesting story:
Suggestions for the Alumni & Friends Association?
YesNo
Yes
Gift $ Amount:
I wish to be billed for total amountI will send check payable to the Iowa Lakes Community College FoundationI wish to make payment using a credit card and would like to be contacted
By submitting this form, I understand that I hereby give the Alumni & Friends Association permission to use my name and information (excluding address, social security number, date of birth and email address) to promote the association and/or college.

Thank you for your loyalty and support!
You may also print, complete and mail this form to:

Iowa Lakes Alumni & Friends Association
19 South 7th Street
Estherville, IA 51334
Should be Empty: