Southeastern Louisiana University

Alumni Dues Form

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Southeastern Louisiana University
Alumni Association

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.

Fields marked with an * are required.

Alumni Membership Dues $30 Individuals $50 Dual (alumnus spouse) $65 Dual (non-alumnus spouse)
$5 alumnus I.D. Fee How many?: $
$750 Alumni Lifetime Membership

"Friends of the Alumni" Membership Dues $55 Member   $35.00 Spouse
$25.00 non alumnus I.D. Fee   How Many?: $
$1,500 Friends Alumni Lifetime Membership

Alumni Donation $10 $25 $50 Other: $

Total Payment

Dues & Donation:*

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:

Payment Information    I want to pay with my *

This field is required. Please select an option.

      Master Card    Visa
   Account Number:*

   Expiration Date:*

   Today's Date:*

Thank You!

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Member of the University of Louisiana System · Accredited by the Southern Association of Colleges and Schools (SACS)
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Southeastern Louisiana University Alumni Association

Southeastern Louisiana University
Alumni Association