<h2><a href="http://siuealumni.wildfire.net/wum5/viewer?ACTION=DrillDown" target="_blank">Join Now!</a> | Join by Form | <a href="/id0904f67a8039a341">Membership Benefits</a></h2>&nbsp;&nbsp;<table> <tr> <td height="245" valign="top" width="505"> <table border="0" width="460" cellspacing="0" cellpadding="0"> <tr> <td> <h3><!-- InstanceBeginEditable name="bodytext" -->Become A Member : Printable Membership Form</h3> <p class="textbody">To join the SIUE Alumni Association fill out and print this form and mail it along with your check or credit card information to:</p> <blockquote> <p class="textbody"><strong><span class="textbodybold">SIUE Alumni Association</span></strong><br /> Campus Box 1031<br /> Edwardsville, IL 62026-1031</p> </blockquote> <p class="textbody">You may also stop by the office on the first floor of Birger Hall to drop off your application.</p> <form name="form1" action="" method="post"> <table border="0" width="455"> <tr align="center"> <td class="head2a" colspan="2"> <h3 align="center">Printable Membership Form</h3> </td> </tr> <tr> <td colspan="2"><strong><span class="textbodybold">1. Privacy Information</span> <span class="text1">(Please check one)</span></strong></td> </tr> <tr> <td class="head2a" colspan="2"> <table border="0" width="443"> <tr> <td valign="top" width="31" align="right"><input name="checkbox" type="checkbox" value="checkbox" /></td> <td valign="top" width="429" class="text1">Yes! I want my e-mail address to be included in the Alumni Online Directory listed on the SIUE Alumni website.</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox2" type="checkbox" value="checkbox" /></td> <td valign="top" class="text1">Yes! I would like to receive occasional emails announcing new benefits and events.</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox3" type="checkbox" value="checkbox" /></td> <td valign="top" class="text1">Please update my information with the alumni office only. I do not want my name and e-mail address to appear on the Alumni Online Directory.</td> </tr> </table> </td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>2. Your Information</strong></td> </tr> <tr> <td width="127" class="text1" align="right">Last Name</td> <td width="318"><input name="textfield" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">First Name</td> <td><input name="textfield2" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Middle Name</td> <td><input name="textfield3" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Maiden Name</td> <td><input name="textfield4" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Title Select title<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />Mr. <input name="checkbox5" type="checkbox" value="checkbox" /> Mrs. <input name="checkbox6" type="checkbox" value="checkbox" /> Ms. <input name="checkbox7" type="checkbox" value="checkbox" /> Miss. <input name="checkbox8" type="checkbox" value="checkbox" /> Dr.</td> </tr> <tr> <td class="text1" align="right">SIUE Class Year(s)</td> <td><input name="textfield5" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">SIUE Degree(s)</td> <td><input name="textfield8" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">E-mail</td> <td><input name="textfield7" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Home URL</td> <td><input name="textfield6" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>3. Spouse Information</strong></td> </tr> <tr> <td colspan="2"> <table border="0" width="442"> <tr> <td valign="top" width="31" align="right"><input name="checkbox9" type="checkbox" value="checkbox" /></td> <td valign="top" width="429" class="text1">Yes! My spouse is an alumna/us.</td> </tr> </table> </td> </tr> <tr> <td class="text1" align="right">Last Name</td> <td><input name="textfield" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">First Name</td> <td><input name="textfield2" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Middle Name</td> <td><input name="textfield3" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Maiden Name</td> <td><input name="textfield4" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Title Select title<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />Mr. <input name="checkbox5" type="checkbox" value="checkbox" /> Mrs. <input name="checkbox6" type="checkbox" value="checkbox" /> Ms. <input name="checkbox7" type="checkbox" value="checkbox" /> Miss. <input name="checkbox8" type="checkbox" value="checkbox" /> Dr.</td> </tr> <tr> <td class="text1" align="right">SIUE Class Year(s)</td> <td><input name="textfield5" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">SIUE Degree(s)</td> <td><input name="textfield8" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">E-mail</td> <td><input name="textfield7" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Home URL</td> <td><input name="textfield6" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>4. Mailing Information</strong></td> </tr> <tr> <td class="text1" align="right">Address</td> <td><input name="textfield62" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">City</td> <td><input name="textfield63" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">State</td> <td><input name="textfield64" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Country</td> <td><input name="textfield65" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Zip Code</td> <td><input name="textfield66" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Home Telephone</td> <td><input name="textfield67" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>5. Work Information</strong></td> </tr> <tr> <td class="text1" align="right">Job Title</td> <td><input name="textfield672" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Company Name</td> <td><input name="textfield673" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Address</td> <td><input name="textfield674" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">City</td> <td><input name="textfield675" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">State</td> <td><input name="textfield676" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Zip Code</td> <td><input name="textfield677" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Work Phone</td> <td><input name="textfield678" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td class="text1" align="right">Fax</td> <td><input name="textfield679" size="30" maxlength="30" type="text" /></td> </tr> <tr> <td colspan="2"><strong><span class="textbodybold">6. Memberships</span> <span class="text1">(Please check one)</span></strong></td> </tr> <tr> <td colspan="2"> <table border="0" width="445"> <tr> <td valign="top" width="31" align="right"> <p><input name="checkbox10" type="checkbox" value="checkbox" /></p> </td> <td width="404" class="text1"> <p>New Graduate Membership $15<br /> (only available first two years after graduation)</p> </td> </tr> <tr> <td valign="top" align="right"><input name="checkbox11" type="checkbox" value="checkbox" /></td> <td class="text1">Annual Membership $25</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox22" type="checkbox" value="checkbox" /></td> <td class="text1">Annual Joint Membership $30</td> </tr> <tr> <td valign="top" class="textbody" colspan="2">Single Life Membership Options</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox322" type="checkbox" value="checkbox" /></td> <td class="text1">Full Payment $300</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox323" type="checkbox" value="checkbox" /></td> <td class="text1">Installments $50 (a year for 6 years)</td> </tr> <tr> <td class="textbody" colspan="2">Joint Life Membership Options</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox325" type="checkbox" value="checkbox" /></td> <td class="text1">Full Payment $350</td> </tr> <tr> <td valign="top" align="right"><input name="checkbox326" type="checkbox" value="checkbox" /></td> <td class="text1">Installment $50 (a year for 7 years)</td> </tr> </table> </td> </tr> <tr align="center"> <td height="50" class="text1" colspan="2"><input name="reset" type="reset" value="Reset" /></td> </tr> </table> </form> </td> </tr> </table> </td> </tr></table>