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

Last name used at Steinmetz, 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 (Cell, Family, etc)

Alternate Phone Type

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 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.