Clinton Community College Alumni Association Membership Form

Please print, complete, and mail to:
    Clinton Community College Alumni Association
    1000 Lincoln Blvd.
    Clinton, Iowa 52732 
 
Applying for a Membership: 
    Annual ($10)     Lifetime ($100) 
  
As a: 
    Graduate     Former     Student     Friend of the College 
  
 
Payment Options: 
    Payment is Attached
         (Make check payable to Clinton Community College Alumni Association.)

    Please Bill Me
 
 
Name ________________________________  Maiden ________________________________

Address ______________________________________________  Phone__________________
 
City_________________________________________ State_____________ Zip____________
 
Place of Employment ____________________________________________________________
 
Address ______________________________________________ Phone___________________ 
 
City_________________________________________ State_____________ Zip____________

Yr. Graduated/Last Attended _________ Program _____________________________________
 
Highest Degree Earned (Any College) _______________________________________________
 
Colleges Attended ______________________________________________________________
 
Spouse's Name____________________________________________ Is Spouse an Alumni? Y / N
 
Community Activities ____________________________________________________________

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