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Personal Info

Title

Mr. Mrs. Ms. etc.

Full Name

Suffix

Jr. Sr. etc.

Former Surname(s)

List any former/maiden names

Date of Birth

Contact Info

Address

Address Line 1

City

State

Zip Code

Recieve the Alumni Columns magazine?

I wish to recieve the Alumni Columns magazine

Email

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Sign up for Purple Pulse Email Newsletter?

I wish to receive the Purple Pulse Email Newsletter

Phone

Is this a cell phone or landline?

Cell Phone
Landline

Degree Information (Optional)

Would you like to update your degree information?

Yes
No

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Minor

If applicable

Do you have any additional degrees from NSU?

Yes
No

List any additional degrees you've recieved from NSU:

Spouse Information (Optional)

Would you like to update your spouse information?

Yes
No

Spouse Title

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Suffix

Is your spouse a NSU Graduate?

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No

Spouse Graduation Year

Spouse Former Name(s)

List any former/maiden names

Employment Information (Optional)

Would you like to update your employment information?

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No

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Address

Address Line 1

City

State

Zip Code

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Student Involvement (Optional)

Did you participate in any Student Organizations or Athletics?

Yes
No

What student organization(s) were you a member of at NSU?

What NSU athletics were you involved with?