* Yes, please send my Alumni Card to my preferred address.
Personal Information / Home Address:
Salutation:
* First Name:
Middle Name:
* Last Name:
Last name at Graduation
(if different from above):
* Birth Date:
Is your spouse an alum?
Spouse Name:
Apartment #:
* Address:
P.O. box:
* City:
* Country:
Province/State:
* Postal/Zip Code:
* Telephone: xxx-xxx-xxxx
* Email:
* Email Confirmation:
 
Occupational Information
Position/title:
Self Employed:
Company:
Division/Department:
Suite #:
Address:
P.O. Box:
City:
Country:
Province/State:
Postal/Zip Code:
Company Email
Telephone: xxx-xxx-xxxx
Check for preferred Email: Personal   Business
Check for preferred Address: Personal   Business
 
York Academic Information
Student Number:
* Faculty:
* Graduation Year:
College (if applicable):
Major(s):