Name (First (Maiden) Last):   Class of:
Address:
City:   State: Zip:

Phone:   Email:
Would you like your email address published on our web site? Yes No

Social Security#:

Spouse Name:
Children(s) Name(s)/Age(s):


If you have high school or junior high age children, would you be interested in receiving our Viewbook/Information packet? (Our current student population comes from 34 parishes and 19 school districts in the Bucks/Montco region.)
Please Choose Yes No

College You Attended: Graduation Year:
Degree/Major: Additional Degrees/Honors:

Employer: Professional Title:
Address:
City: State: Zip:
Business Phone: Fax:

Does your employer or spouse's employer have a Matching Gift Program?
Please Choose Yes No

Would you be interested in participating in a future Career Day at LC?
Please Choose Yes No

Activities/Athletics/Organizations you participated in while at LC:

Alumni Notes Update (job promotion, marriage, birth announcement, awards received, etc) to be posted on Alumni Happenings Webpage.  You may also send photo attachments (jpg preferred) to kmaginnis@lansdalecatholic.com

This information is confidential and will be used for the LC Institutional Advancement/Alumni Affairs Office only.