Name:
Class Year(s): Degree(s)/Certificate(s):

Spouse:
Class Year(s): Degree(s)/Certificate(s):

Address:
City: State: Zip:

Personal Email:   Phone Number

Name at graduation (if different)

Children (optional)

Name /age:
Name /age:
Name /age:

Employer:
Title:
Business Address:
City: State: Zip:

Business Phone Number: Fax:

Business E-mail:

Business Web Address:

Description of your Business Services:

* DO you prefer to be contacted at your business or personal e-mail address?

Community Service:
Do you volunteer to strengthen your community? Please list your volunteer commitments:


Has anyone else in your family ever attended JJC? If so please list their names below (we would like to highlight multi-generational JJC alumni in upcoming issues of the Alumni Action newsletter):

 

Comments:
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