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Serteens Alumni Information Collection
A PDF copy of this form may be obtained at
https://honolulusertoma.org/alumni
or by emailing
SerteensAlumni@honolulusertoma.org
.
If your contact information contains an international address or phone number, please submit your information via the PDF form.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Former name(s)
Your answer
Mailing address
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Email address
Your answer
Cell phone number
Your answer
Alternate phone number
Your answer
Background Information
High school graduated
*
Your answer
High school year graduated
*
Your answer
Undergraduate degree institution
Your answer
Undergraduate degree
Your answer
Year graduated
Your answer
Graduate degree institution
Your answer
Graduate degree
Your answer
Graduate degree year graduated
Your answer
Professional Certifications
Your answer
Occupation (current or most recent)
Your answer
Employer (current or most recent)
Your answer
Are you retired? (If yes, please fill in your pre-retirement occupation and employer above.)
Yes
Other noteworthy information about myself
Your answer
Please check all that apply to you
Put me on the email list to get reunion notices and a yearly email newsletter.
Send me periodic notices for upcoming Honolulu Sertoma and/or Serteens events.
I am willing to be a mentor to the Serteens, if you need my help.
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