Alumni Association Membership Form 2019 Alumni Association Membership Form 2019 Name (As you wish for it appear on your membership card)* First Last Name (As you were known on campus. Maiden, nickname, etc.)* First Last Years Attended*Year Graduated*Major/Degree*Campus*OnlineMontgomeryBirminghamHuntsvilleMobileAlexander CItyAndalusiaAnnistonChildersburgCorinth, MSDothanGadsdenGreenvilleHancevilleOpelikaSelmaTalladegaThomasvilleGroups/Teams while at FaulknerChorus, SGA, Social Club, Athletic Team, etc.Current Employment/ Field of Work*Primary Phone*Alternative PhoneEmail* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your spouse a Faulkner alumni?*YesNoNot ApplicableSpouse First Last Spouse's Name (As they were known on campus. Maiden, nickname, etc.)* First Last Spouse's Major/Degree*Spouse Attended Campus*OnlineMontgomeryBirminghamHuntsvilleMobileAlexander CItyAndalusiaAnnistonChildersburgCorinth, MSDothanGadsdenGreenvilleHancevilleOpelikaSelmaTalladegaThomasvilleSpouse's Groups/Teams while at FaulknerChorus, SGA, Social Club, Athletic Team, etc.Years Spouse Attended*Year Spouse Graduated*Spouse's Current Employment/ Field of Work*Spouse's Primary Phone*Spouse's Alternative PhoneSpouse's Email* Enter Email Confirm Email Membership*1 Year Single Membership ($25)1 Year Membership with Spouse ($40)Lifetime Single Membership ($250)Lifetime Membership with Spouse ($400)Alumni Gift*Car Tag FrameUmbrellaT-shirtShirt Size*SmallMediumLargeX-LargeXX-LargeAdditional commentsTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms. Form has been tagged under:Alumni Skip back to main navigation