Alumni

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Become A Member : Printable Membership Form

To join the SIUE Alumni Association fill out and print this form and mail it along with your check or credit card information to:

SIUE Alumni Association
Campus Box 1031
Edwardsville, IL 62026-1031

You may also stop by the office on the first floor of Birger Hall to drop off your application.

Printable Membership Form

1. Privacy Information (Please check one)

	Yes! I want my e-mail address to be included in the Alumni Online Directory listed on the SIUE Alumni website.
	Yes! I would like to receive occasional emails announcing new benefits and events.
	Please update my information with the alumni office only. I do not want my name and e-mail address to appear on the Alumni Online Directory.

2. Your Information

Last Name

First Name

Middle Name

Maiden Name

Title Select title

Mr. Mrs. Ms. Miss. Dr.

SIUE Class Year(s)

SIUE Degree(s)

E-mail

Home URL

3. Spouse Information

Yes! My spouse is an alumna/us.

Last Name

First Name

Middle Name

Maiden Name

Title Select title

Mr. Mrs. Ms. Miss. Dr.

SIUE Class Year(s)

SIUE Degree(s)

E-mail

Home URL

4. Mailing Information

Address

City

State

Country

Zip Code

Home Telephone

5. Work Information

Job Title

Company Name

Address

City

State

Zip Code

Work Phone

Fax

6. Memberships (Please check one)

	New Graduate Membership $15 (only available first two years after graduation)
	Annual Membership $25
	Annual Joint Membership $30
Single Life Membership Options
	Full Payment $300
	Installments $50 (a year for 6 years)
Joint Life Membership Options
	Full Payment $350
	Installment $50 (a year for 7 years)

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Alumni

Join Now! | Join by Form | Membership Benefits

Become A Member : Printable Membership Form

Printable Membership Form