Wufoo

Name * First Last
Email *
Phone
Address
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Describe your involvement with UAEM *
I am an alumnus/alumna of a UAEM chapter I am a current member of a UAEM chapter I am a supporter of UAEM
If an alum, which years were you involved?
At which university? *
What was your field of study?
How do you want to be involved in the alumni network?
Leadership role / Governance Mentor a chapter Mentor a student (personal/professional mentoring) Fundraise Professional networking with other alumni Local advocacy Social gatherings in my area National alumni reunion Other (please specify in next field)

Check as many as apply
Are there other relationships you have which would be relevant to UAEM, such as current or former employers, non-profit organizations, additional universities you attended or are attending, partner or family universities, etc.?

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