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Alumni & Friends Association Membership

By submitting this form, I understand that I hereby give the Alumni & Friends Association permission to use my name and information (excluding address, social security number, date of birth and email address) to promote the association and/or college.
  
Thank you for your loyalty and support!

Indicates a Required Field
First Name:
Middle Initial:
Last Name:
Social Security Number OR last four digits:
Date of Birth:
Maiden/Birth Name:
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Email Address:
Campus Attended:
Major(s) / Program:
Diplomas / Certificates Awarded:
AA
AS
AAS
Certificate
None
Year of Graduation:
Occupation:
Hobbies:
Iowa Lakes Alumni:
Yes
Friend of Iowa Lakes:
Yes
News to share: family, career, interesting story:
Suggestions for the Alumni & Friends Association?:
Interest in serving on the Alumni & Friends Board?:
Yes
No
I would like to join the Alumni & Friends Assn:
Yes
Gift $ Amount:
Please indicate Payment Option:
I wish to be billed for total amount
I will send check payable to the Iowa Lakes Community College Foundation
I wish to make payment using a credit card and would like to be contacted
Verification Code:
Questions or comments? Please email us at info@iowalakes.edu or call 712-362-2604 or 800-521-5054.
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