| Personal
information |
| Name: |
|
| Class year if
you attended Mines: |
|
| Preferences |
Preferred
address for correspondence: |
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Preferred
address for email correspondence: |
|
Information
Sharing
Please check all that apply: |
Do not put my information
in the online directory -
accessible only by CSMAA members.
Do not put my preferred address in
the directory.
Do
not put my preferred email in the directory.
Do not put my home phone in the
directory.
Do not put my business phone
in the directory. |
Can
other
alumni or current
students contact you for networking purposes? |
|
Would you consider participating in a mentor
program for students or young alumni? |
|
Would you be willing to help with sectional
events/alumni gatherings in your area? |
|
| Home
address and phone (if new) |
| Address: |
|
| City: |
|
| State/province: |
|
| Zip/postal
code: |
|
| Country: |
|
| Phone: |
|
E-mail : |
|
| Employment
and business address and phone (if new) |
| Job title: |
|
| Occupation: |
|
| Company name: |
|
| Work address: |
|
| City: |
|
| State/province: |
|
| Zip/postal
code: |
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| Country: |
|
| Phone: |
|
| E-mail: |
|
| Internet
address |
| Home page: |
|
| Membership
Type |
|
Membership Type: |
Renewing
New
Payment on Life Membership
|
| Membership
categories |
Regular
(graduate) and
Associate (non-graduate): |
$55.00 - Annual.
$110.00 - Join for
2008
& 2009
$75.00 - Joint.
Both spouses have graduated from Mines.
$150.00 - Join for 2008
& 2009
|
| Special: |
This category
recognizes alumni who find themselves unemployed or otherwise in financial difficulties.
These members are counted as active members, are not distinguished in any way from other
members and have all the rights and privileges of an active member.
$20.00 - Special. |
| Senior: |
Dues are free if you graduated in the class of 1964 or earlier.
Senior |
New Life membership:
|
Life membership is
$1,000.
Joint
life membership is $1,250. Both spouses have graduated from Mines.
(NOTE: As of July, 2008, Joint Life memberships
will increase to $1,750. Lock in your $1,250 now!)
Select a payment period if you have checked life or joint life membership:
|
Payment on Life membership:
(enter amount of payment)
|
|
| Gifts
to Alumni Association |
General
operating fund:
(where funds are needed most) |
|
Student
financial assistance:
(for Legacy grants, field session grants, and other awards) |
|
| Endowment
fund: |
|
| If
you wish to pay by credit card |
| Credit card
type: |
|
| Credit card
number: |
|
Security
Number:
(what is this?) |
|
| Name on card: |
|
| Card expiration
date: |
|
| Comments,
questions, observations |
| Enter any
here. |
|
| |