Reunion 2010 - Alumni Weekend Reunion Survey and Class Notes

1.  First and Last Name:                          Class Year:
      *         

    Maiden Name (If Applicable):
     

    Address:
     *
     

    City:                               State:
     *     *

    Zip Code:                        Phone:
     *     

    Home E-mail:
     *

    E-mail (confirm):
      *

2. Job Title:
      *

    Business Name:
     *

    Business Address: *
     
     

    City: *                         State: *
          

    Zip Code: *                  Phone:*
          

    Business E-mail:
     

3.  Non-Profit/Board Affiliations:
      


4.  Does your employer have a Matching Gift Program?
       Yes     No


5.  Marital Status: 
       Married   Single   Divorced   Widowed  Life Partner

     Spouse/Partner Name:
       

6.  Child's Name:                                                Birth Date:
               
               
               

7.  Are you planning to return for Reunion 2010?*
        Yes       No      Maybe

     Would you be interested in joining your reunion committee? *
        Yes       No

     If YES, please indicate the area(s) you are most interested in (check all that apply):
       Recruitment of Classmates
       Events Planning
       Reunion Giving Challenge

     Suggestions for class-specific events:
       

     Classmates you would like to see at Reunion:
       

     Favorite Faculty Member(s):                   Area of Study:
            
            

7.  Nomination for Distinguished Service Award:
      This award is the Alumni Association’s highest honor. It recognizes Clark alumni
      for their extraordinary dedication to the University. This award will be presented
      on Reunion weekend 2010 - Alumni Weekend. Eligible candidates must be
      Clark alumni and have demonstrated exceptional leadership, dedication and
      volunteerism to the University.

     Name:                                                  Class Year:
            

8. Nomination for Young Alumni Award (2000-2009):
      This award recognizes young alumni for outstanding service to Clark and
      extraordinary achievements in their communities and professions. This award
      will be presented on Reunion 2010 - Alumni Weekend. Eligible
      candidates must be Clark alumni who have demonstrated exceptional service
      to the University through volunteer effort and have distinguished
      professional or community service.

     Name:                                                  Class Year:
            

9. CLASS NOTES - Share your latest family, career or travel news: