Illinois Alumni Club of Greater Springfield Organizational Survey
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Full Name
Maiden/Former Name (if applicable)
Primary Phone Number
Preferred Email Address
Street Address
Zip Code
Graduation Year(s)
Spouse/Life Partner's Name (if applicable)
Is your spouse/life partner a U of I graduate?
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What activities are of most interest to you? (Check all that apply)
Would you be willing to serve on the leadership team or on a planning committee?
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 What days/times are most convenient for you? (Check all that apply)
Do you know other U of I alumni in the area that we should contact? Please list name(s), phone number(s) and email(s) below:
Other comments/suggestions:
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