Alumni Information Request Form

Berkeley Aquatic Club would like to know what is happening with our graduates. Please provide the following information. Please note that all information you provide will be kept confidential. The information with the " ** " will be posted on our site along with the colleges and universities you have attended or are currently attending and the year you graduated Berkeley Aquatic Club. Please provide all information we request.

Also note that we will not post any of your emails on our site to protect your privacy.

Please enter the year you graduated Berkeley Aquatic Club:

Please provide the following contact information:

First Name **

Last Name **

Maiden Name **

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

E-mail

Please enter the college or University you have attended and which degree you have acquired. Please note only the University or College name will be posted on the site.

Associates Bachelors Masters Doctorates

Family Status:

Marital Status

(please note this option can be left blank if you would like not to answer)

Single Married

If you have any children please provide their names. If you have more then one child please separate each name by a comma.

First Name	**
Last Name	**
Maiden Name	**
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Alumni Information Request Form

Revised: 06/11/06