Please Print or Type your name legibly.

Include news of fellow Ikesters if possible.

Name:

Maiden Name:

Graduation Year:     Date Filled Out:

Home Address:

City:State: Zip Code:

Business Address (include title and company name):

Check Box if this is New Information

Email Address:

Home phone number with area code:

Business phone number with area code:

News of Fellow Ikesters:

Print and Return To:

Eisenhower College Alumni Association, Inc.

Alumni Records Office

P.O. Box 876

Ithaca, NY 14851-0876