News & Notes Form

Personal Information

Full Name
Name used while attending NC State
Date of Birth
Street
City
State
ZIP/Postal Code
Class Year
Degree/Major
Non-NC State Degrees earned:
Non-NC State Degree Institution:
Home Phone (include area code)
Alternate Phone (include area code)
Fax Number (include area code)
Home e-mail address
Personal web site (if any)
Dates attended NC State

Employer
Position
Occupation
Street
City
State
ZIP/Postal Code
Business Phone (include area code)
Alternate Phone (include area code)
Fax Number (include area code)
Business e-mail Address
Business web site

Spouse's Name
Did spouse attend NC State University (If no, skip to Today's Date)
Spouse name while attending NC State
Dates attended
Degree/Major
Today's Date

Clubs and Organizations while attending NC State

Class Notes (For publication; please be as detailed as possible)

I would be interested in assisting with the following Activities:

Events / Reunion
Outreach / Recruiting
Public Relations
Financing / Fundraising
Scholarship Comittee
Trips for Alumni & Friends

Skills or Special Interests You Could Offer The Society