Hoosiers for Higher Education Membership Registration Form

Please complete the following form to sign up as a member of Hoosiers for Higher Education. Membership is FREE, but your support is invaluable.

All items marked with an asterisk (*) must be filled out to complete your registration.

* - Indicates required field
Name*
First Name *
Middle Name
Last Name *
Last name while at IU
    

Relationship to IU

Alumni & Friends
Graduate
Attended IU but have not graduated
Member of the IU Alumni Association
Friend of IU, Never attended

Year(s) Attended

Student
Undergraduate
Graduate/Professional

Expected Graduation Date

Month   Year

Faculty & Staff
Faculty
Staff
Retired Faculty
Retired Staff

Address*
(Home address is needed to match with your local legislative districts.)

Street Address *
City *
State *
Zip *

Business Address
Street Address
City
State
Zip

Contact Information
Email Address *

(Your email address will not be shared with outside parties and will only be used to contact you about IU related matters.)
Home Phone
( ) - 		Work Phone
( ) - 		Cell Phone
( ) -
What is the best way to contact you?




Assist HHE
Please note my interest in serving:
(Click here to learn more)


Please list any state legislators that you know.

  

Indiana University - Quality Education. Lifetime Opportunities
101 W. Ohio Street, Suite 1776
Indianapolis, IN 46204
(317) 681-1776
Last updated: 4 April 2008
Comments: gov@indiana.edu
Copyright 2008, the Trustees of Indiana University
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