THANKS FOR UPDATING!

Note - this form should NOT be used to renew your membership or to join the club. It should ONLY be used to provide updated information to the club.

Please provide the following contact information, where access will be restricted to Club officers (periodically shared with the UIAA.) Note that bold blue labels indicate required information. Thanks!

Member's First Name

Member's Last Name

E-Mail address

Secondary E-Mail address
(Note - while not necessary, please provide to ensure the club's ability to contact you should your primary email become inactive.)

Address

City

State

Zip/Postal Code

Home Phone

Work Phone

FAX

Campus

Class of (graduation year)

Degree (e.g. B.S., M.S., M.B.A., Ph.D., etc.)

Curriculum (e.g. Chemical Engineering, Business, etc.)

Non-U of I Class, Degree, and University

Home town, home state

Employer

I am interested in serving as a club (use the control key to select more than a single item):

I am eligible to be exempted from dues since I graduated from U of I either within the last three, or more than 50 years. My last U of I degree was in:

The following is optional information for married club members:

Spouse's Name (First)

Spouse's Name (Last)

Spouse's E-Mail address

Spouse's University

Spouse's Class

Spouse's Degree

Spouse's Curriculum

Spouse's Home town, home state

Spouse's Employer

Spouse's Work Phone