Southeastern Louisiana University

Alumni Dues Form

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Alumni Membership:
	Any person who has attended Southeastern at least two semesters and earned 24 credit hours as certified by the Office of the Registrar.
"Friends of the Alumni" Membership:
	Any person who wants to support the Southeastern Alumni Association but does not qualify under Alumni Membership.

Personal Information:

Alumnus' Name
Year Graduated
SS No.
Spouse Name
	Southeastern Alum?	Yes No
Spouse SS No.
Mailing Address
City
		State Zip
Home Phone
Work Phone
Email Address
Has address changed?		Yes No
Organizational Affiliations
	Greek Affiliation
	Academic Affiliation
	Athletic Affiliation
Parent of current Southeastern student?		Yes No
	Name of Student
	Anticipated Graduation Yr.
Would you like to refer a prospective student?
	Name
	Mailing Address
	City
		State Zip

	I want to pay with my	Mastercard Visa
	Account Number
	Expiration Date
	Today's Date

Thank You!

Alumni Membership Dues	"Friends of the Alumni" Membership Dues	Alumni Donation
$30 Individuals $50 Dual (alumnus spouse) $65 Dual (non-alumnus spouse) $5 alumnus I.D. Fee How many? $750 Alumni Lifetime Membership	$55 Member $35.00 Spouse $25.00 non alumnus I.D. Fee How Many? $1,500 Friends Alumni Lifetime Membership	$10 $25 $50 Other
Total Payment: Dues & Donation