St. Cloud State University

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Name of alumnus/a:

Maiden Name: (if applicable)

SCSU Class year:

Name of Partner:

Maiden Name: (if applicable)

Is your Partner a SCSU Alumnus/a?

Yes
No

Class year:

Please choose: Son Daughter Twin-daughter Twin-son

Baby's name:

Baby's name: (if twins)

Birth Date:  (mm/dd/yyyy)

Name:   Date of Birth: (mm/dd/yyyy)
Name:   Date of Birth: (mm/dd/yyyy)
Name:   Date of Birth: (mm/dd/yyyy)
Name:   Date of Birth: (mm/dd/yyyy)

We will use this information to send you a Husky Pup T-shirt!

Address:

Home Phone:   Work Phone:

Home E-mail:

Would you like to receive, via e-mail, updates on upcoming alumni social activities in your area and other news on SCSU?
Yes
No

Submitted by:

Phone:

Relationship to alumnus/a: