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 ____________________________________________________________
______________________________________________________________________________