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Contact Information
Salutation:
*First Name:
Middle Initial:
*Last Name:
Maiden Name:
Nickname:
Address:
 
City:
State:
Zip:
Home Phone:
Home Fax:
Mobile Phone:
Home Email:

Affiliation
Alumni/ae  Current Parent  Parent of Alumni/ae 
Grandparent  Friend  Faculty/Administration 

Personal Information
Gender: M   F
Birth Date:

Education Information
Year Graduated Mater Dei:
College/University:
Degrees/Years:

Company Information
Company:
Work Address:
 
City:
State:
Zip:
Work Phone:
Work Fax:
Work Email:
Work Title:
Industry/Field:
Company Match Gifts? Yes   No

Spouse Information
First Name:

Last Name:

Maiden Name:

Company:
Work Address:
 
City:
State:
Zip:
Work Phone:
Work Fax:
Work Email:
Work Title:
Industry/Field:
Company Match Gifts? Yes   No

Spouse Affiliation
Alumni/ae  Current Parent  Parent of Alumni/ae 
Grandparent  Friend  Faculty/Administration 

Comments

Willing to Volunteer? Yes   No

Select all of the following that interests you:
Alumni Council  Class Agent  Fundraising 
Golf Outing  Hall of Fame  Mentor Students  
Other 

I have the following area of expertise and would be willing to volunteer my services:
(Some services may be eligible for "gift-in-kind" charitable deduction status.)

Accounting  Computer Technology  Event Management
Fundraising Graphic Design  Legal
Marketing Printing/Production  
Other 

Class Reunion Information:
Has your class had a reunion recently? Yes   No
If yes, is there a list available? Yes   No
Who organized the reunion?
Name:
Phone:

Are you registered on other alumni tracking sites?
Classmates.com  Highschool.com   
Other 

Please provide the names and addresses of other Mater Dei alumni who you think would like to receive information on the alumni association: