SUNY Potsdam Alumni Information Update Form

Name:

(first, middle, last)

Class Year:

Address:

City:

State:

Zip:

Phone:

Business Phone:

E-mail:

Publish Name:

Yes

No

May we publish your E-mail address on our Web site?

Web site:

Publish site:

Yes

No

May we publish your Web site address on our Web site?

Employer:

Position:

Employer's address:

Spouse/Partner's Name:

Alum?:

Yes

No

Is your spouse/partner a SUNY Alum?

Class Year:

Spouse/Partner's Employer:

Spouse/Partner's Position:

Child's/Children's Name(s):

Gender:

M

F

Birth date:

Child's/Children's Name(s):

Gender:

M

F

Birth date:

Child's/Children's Name(s):

Gender:

M

F

Birth date:

News:

News for the Class Notes section of Potsdam People

SUNY Potdam

Information Update Form