Personal Information

E-Mail
Alumni/ae Name
Class
Maiden Name
Address
City
State/Province
ZIP/Postal Code
Country (if other than USA)
Home Phone
Home Fax
Advanced Degrees (institution and date)
JCU Affiliations (fraternities, sororities, other groups)

If you have any alternate addresses (summer/winter home, etc.), please indicate them in the notes below.

Business Information

Company
Title
Address
City
State/Province
ZIP/Postal Code
Country (if other than USA)
Business Phone
Business Fax

Which address would you prefer to have your mail sent to?
Home
Business

Family Information

Spouse's Name
Class (if JCU grad)
Spouse's Maiden Name

Children & Ages:

List any news, notes, or other special events you'd like us to know about:

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No

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