Alumni & Friends 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:

Diplomas / Certificates Awarded:

Year of Graduation:

Occupation:

Hobbies:

Iowa Lakes Alumni:

Friend of Iowa Lakes:

News to share: family, career, interesting story:

Suggestions for the Alumni & Friends Association?

Interested in serving on the Alumni & Friends Board?

I would like to join the Alumni & Friends Association:

Gift $ Amount:

Please indicate Payment Option:

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