Marylhurst Alumni Opt-in Form
Please complete this form if you would like to connect with fellow Marylhurst alumni and stay up-to-date on important information, special events and future programs.
Name
*
First Name
Last Name
Middle initial
Name while attending Marylhurst
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
-
Area Code
Phone Number
Phone Type
Cell
Home
Work
Email
*
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Class year
Degree
Major
Other Marylhurst alumni in family?
*
Yes
No
Student comments:
Please include any special instructions.
Please share this form with alumni family members:
Enter the message as it's shown
*
Submit
Should be Empty: