Please print, complete, and mail to:
Clinton Community College Alumni
Association
1000 Lincoln Blvd.
Clinton, Iowa 52732
Applying for a Membership:
Annual ($10) Lifetime ($100)
As a:
Graduate Former Student
Friend of the
College
Payment Options:
Payment is Attached
(Make check
payable to Clinton Community College Alumni Association.)
Please Bill Me
Name ________________________________ Maiden
________________________________
Address ______________________________________________
Phone__________________
City_________________________________________ State_____________
Zip____________
Place of Employment
____________________________________________________________
Address ______________________________________________
Phone___________________
City_________________________________________ State_____________
Zip____________
Yr. Graduated/Last Attended _________ Program
_____________________________________
Highest Degree Earned (Any College)
_______________________________________________
Colleges Attended
______________________________________________________________
Spouse's Name____________________________________________ Is Spouse
an Alumni? Y / N
Community Activities
____________________________________________________________
______________________________________________________________________________