NEW TEST FORM, Steinmetz Alumni Association

Is this a new membership or renewal? *

Please choose one!

Graduation Month/Year *

ex: 6/1952

Name *

First

Last

Name will if

Last name used at Steinmetz (Maiden Name), if different from above.

Email *

Email

Confirm Email

Alternate email

Email

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

IF YOU ARE PAYING VIA CREDIT CARD, PLEASE MAKE SURE THIS MATCHES YOUR BILLING ADDRESS FOR THE CREDIT CARD.

Phone *

Alternate Phone

In case we cannot reach you at your primary contact, we will use this phone number. Please describe your alternate phone number in the next field.

Please describe your alternate phone number.

Cell Phone, Landline, Family, Friend, neighbor, spouse, partner, etc.

Choose your Membership Option *

Membership includes quarterly newsletter subscription with news and information about your classmates and school news!

How will you be paying for your Membership? *

Membership Payment

Item Quantity Qty Total

There are no products selected.

Choose your Membership Option - Two Year Membership 1 $12.00

Choose your Membership Option - Five Year Membership 1 $25.00

Choose your Membership Option - Lifetime Membership 1 $250.00

Total $0.00

Payment Information *

Card Number

Expiration Date

Security Code

Card Holder Name

YOUR PAYMENT WILL NOT PROCESS IF YOUR ADDRESS DOES NOT MATCH THE BILLING ADDRESS OF THE CREDIT CARD.