Alumnae Address/Info Update

First Name: *

Middle Name:

Maiden Name: *

Current Last Name:

Class Of: *

Address:

City:

State/Province: *

Zip/Postal Code: *

Country: *

Home Phone:

Work Phone:

Fax Number:

Email: *

Alt Email:

Occupation:

Employer:

Relatives attending/alumnae of Regina:

(specify names & graduation years)

Activities interested in:

Lenten Lecture Series on women's topics (health, finance, home, faith, marriage)

Girl's Night/Day Out (trip to a play, sporting event, dinner, casino, shopping)

Alumnae Book Club

June Golf Outing

April Alumnae Mass/Brunch

Other (specify below)

Other Activities:

Formalities of an Association:

I'm interested in being my class representative

I'm willing to volunteer to help with alumnae-sponsored events

Other (specify below)

Other ways to help:

Activities w/Student Body:

Career Day

Luncheon to welcome the Senior Class to the Alumnae Association

Mentor a Regina Grad (college frosh; the "If I knew then what I know now..." scenario)

Other

Other Student Activities:

Other Items of Interest to our Office

College/Other Higher Ed:

Spouse's Name:

Spouse's Occupation:

Your Adult Honors/etc.:

Interests/Hobbies:

Travel Experiences:

Church Activities:

Volunteer Work:

Children/Ages:

Comments/Questions:

Please contact me ASAP regarding this matter

PAYMENT OF MEMBERSHIP DUES

(Membership dues are based on our fiscal year of July 1 through June 30)

Payment Method:

My check is in the mail

I'll pay online via credit card (click link on next page)

Amount/Type:

$25.00 in Annual Dues

$10.00 in Annual Dues (students/alumnae over 60 only)

$250 Lifetime Membership

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• Regina High School • 13900 Masonic Blvd. • Warren, Michigan 48088 • Phone: 586-585-0500 • Fax: 586-585-0507
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