ALUMNI REGISTRATION

If you are a B-12 alumnus, please register your contact information here so we can include you in future communication. If your contact information has changed, just input the new information and we will be notified.

LAST NAME:*

FIRST NAME:*

EMAIL ADDRESS:*

PHONE NUMBER:

STREET ADDRESS:

CITY, STATE, ZIP, COUNTRY:

PLEDGE YEAR:*

PLEDGE CLASS #:*

PLEDGE NAME:

P/R RANK UPON RETIREMENT:

GRADUATION YEAR:

MILITARY BRANCH & RANK:

DESIRED INVOLVEMENT:*

ACTIVE

KEEP ME INFORMED

TAKE ME OFF THE MAILING LISTS

COMMENTS: