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*First Name:
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*Preferred Title:
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*Address:
Apt.:
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*Home Phone:
Home Fax:
*Home E-mail:
Spouse's name:
Is your spouse a Queens College graduate?
Year
 

Your organization's name:
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Business Fax:
Business E-mail:
Occupation:
If you are retired, what was your occupation?
Spouse's organization's name:
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Occupation:
If he/she retired, what was his/her occupation?



Date:
Degree:
Major:
Date:
Degree:
Major:
 
School:
Date:
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School:
 
 
 
 
Date:
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Did you belong to a Fraternity/Sorority/Houseplan?
If so, which one?:


I would like to help with:
Planning activities/reunions
Career development
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Student recruitment
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