Fillable Printable Alumni Association - Membership Application

Alumni Association - Membership Application

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ALUMNI ASSOCIATION - MEMBERSHIP APPLICATION

Membership is open to individuals who graduated from a degree or certificate program and/or former students who have completed

30 or more credits at Capital or one of its founding institutions. An official membership card will be forwarded to you.

Name

First Last Ma iden

Home Address

Street City State Zip

Telephone: Email:

Year of Graduation (if applicable)

Program of Study/Year(s) attended

Additional Education:

Your occupation:

Employer

Employer Address

Street City State Zip

Employer Telephone

Spouse/Partner name (if applicable):

Did your spouse/partner attend Capital or a founding institution?

Circle the address where you would like to be contacted: Home Work

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MEMBERSHIP FEES

Check out our Memberships and see how you can help the Alumni Association by paying your membership fee

to the Alumni Association.

If you interested in becoming a member but cannot afford any fee at this time, please contact the President at

Yes, I want to support Capital Community College.

Enclosed is my:

_______Regular membership fee of $20

_______My lifetime membership fee of $100

Please send a check and completed registration form to CCCAA or register on-line using Pay Pal

* Fees will be waived for this graduating class (2007 – 2008) for the first year only.

Return To:

Capital Community College

Alumni Association

950 Main Street Hartford, CT 06103

Telephone: 860-906-5102 Fax: 860-906-5115

E-mail: CA-AlumniAss[email protected]ommnet.edu