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Your Personal Information
First Name:*		Last Name:*
Graduation Year:*		Birthdate	/ /
E-mail Address:
Street Address:
City:		State, Zip	,
Phone:	- -	Fax:	- -
Marital Status:	Single Married Divorced Other

Your Spouse's Information: Recently married/change of name
Spouse's Name:
Is your spouse an ASU alumnus?	Yes No
Spouse Degree:	Graduation Year:
Child's Name:	Birthdate:	/ /
Child's Name:	Birthdate:	/ /
Child's Name:	Birthdate:	/ /

Would you like to sign your children up for the STAGES program?
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Your Business Information Recently changed jobs
Position/Title
Company Name:
Address
City:	State, Zip	,
E-mail	Phone:	- -

Please send me information on the following:
ASU Alumni Association membership	Nominating Someone for Distinguished Alumnus
ASU Visa Card	ASU Collegiate License Plate (Arkansas Residents Only)
Establishing a Scholarship	Planned Giving or Estate Gifts
Admissions Information	ASU Indian Club
All of the Above

I would be willing to assist with:
Coordinating Alumni Activities In My Area	Alumni Association chapter activities
Student Recruitment	Reunion Planning
All of the Above

Please share with us what's going on with you.
Any awards? Accolades? Other news? We'd love to hear from you!