<h2>Update Your Information</h2>
<p class="textbody">Welcome to our online way of keeping connected!<br /><br /> Update your address, let us know of a name change or new phone number now. You do not need to fill out this form if you are joining the Alumni Association today or if you are renewing your membership.</p>
<form name="Alumni Info Form" method="post" enctype="text/plain" action="mailto:alumni@lists.siue.edu?subject=*Alumni Info Form">
<table width="456" border="0">
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<h3>Alumni Information Form</h3>
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<td colspan="2"><span class="textbodybold"><strong>1. Privacy Information</strong></span><span class="text1"><strong>(Please check one)</strong></span></td>
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<td colspan="2" class="head2a">
<table width="450" border="0">
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<td width="27" align="right" valign="top"><input name="INCLUDE ON DIRECTORY" type="checkbox" id="INCLUDE ON DIRECTORY" value="checkbox" /></td>
<td width="413" valign="top" class="text1">Yes! I want my e-mail address to be included in the Alumni Online Directory listed on the SIUE Alumni website.</td>
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<td align="right" valign="top"><input name="RECEIVE EMAIL" type="checkbox" id="RECEIVE EMAIL" value="checkbox" /></td>
<td valign="top" class="text1">Yes! I would like to receive occasional emails announcing new benefits and events.</td>
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<td align="right" valign="top"><input name="NOT ON DIRECTORY" type="checkbox" id="NOT ON DIRECTORY" 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>
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<td colspan="2" class="textbodybold"><strong>2. Your Information</strong></td>
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<td width="118" align="right" class="text1">Last Name</td>
<td width="328"><input name="LAST NAME" type="text" id="LAST NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">First Name</td>
<td><input name="FIRST NAME" type="text" id="FIRST NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Middle Name</td>
<td><input name="MIDDLE NAME" type="text" id="MIDDLE NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Maiden Name</td>
<td><input name="MAIDEN NAME" type="text" id="MAIDEN NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Title Select title<br /></td>
<td class="text1"><input name="MR" type="checkbox" id="MR" value="checkbox" />Mr. <input name="MRS" type="checkbox" id="MRS" value="checkbox" /> Mrs. <input name="MS" type="checkbox" id="MS" value="checkbox" /> Ms. <input name="MISS" type="checkbox" id="MISS" value="checkbox" /> Miss. <input name="DR" type="checkbox" id="DR" value="checkbox" /> Dr.</td>
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<td align="right" class="text1">SIUE Class Year(s)</td>
<td><input name="GRAD YEAR" type="text" id="GRAD YEAR" size="30" maxlength="30" /></td>
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<td align="right" class="text1">SIUE Degree(s)</td>
<td><input name="DEGREES" type="text" id="DEGREES" size="30" maxlength="30" /></td>
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<td align="right" class="text1">E-mail</td>
<td><input name="EMAIL" type="text" id="EMAIL" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Home URL</td>
<td><input name="URL" type="text" id="URL" size="30" maxlength="30" /></td>
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<td colspan="2" class="textbodybold"><strong>3. Spouse Information</strong></td>
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<td colspan="2">
<table width="450" border="0">
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<td width="31" align="right" valign="top"><input name="SPOUSE IS AN ALUMNA" type="checkbox" id="SPOUSE IS AN ALUMNA" value="checkbox" /></td>
<td width="409" valign="top" class="text1">Yes! My spouse is an alumna/us.</td>
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</table>
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<td align="right" class="text1">Last Name</td>
<td><input name="S LAST NAME" type="text" id="S LAST NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">First Name</td>
<td><input name="S FIRST NAME" type="text" id="S FIRST NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Middle Name</td>
<td><input name="S MIDDLE NAME" type="text" id="S MIDDLE NAME" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Maiden Name</td>
<td><input name="textfield4" type="text" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Title Select title<br /></td>
<td class="text1"><input name="S MR" type="checkbox" id="S MR" value="checkbox" />Mr. <input name="S MRS" type="checkbox" id="S MRS" value="checkbox" /> Mrs. <input name="S MS" type="checkbox" id="S MS" value="checkbox" /> Ms. <input name="S MISS" type="checkbox" id="S MISS" value="checkbox" /> Miss. <input name="S DR" type="checkbox" id="S DR" value="checkbox" /> Dr.</td>
</tr>
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<td align="right" class="text1">SIUE Class Year(s)</td>
<td><input name="S GRAD YEAR" type="text" id="S GRAD YEAR" size="30" maxlength="30" /></td>
</tr>
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<td align="right" class="text1">SIUE Degree(s)</td>
<td><input name="S DEGREES" type="text" id="S DEGREES" size="30" maxlength="30" /></td>
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<td align="right" class="text1">E-mail</td>
<td><input name="S EMAIL" type="text" id="S EMAIL" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Home URL</td>
<td><input name="S URL" type="text" id="S URL" size="30" maxlength="30" /></td>
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<td colspan="2" class="textbodybold"><strong>4. Mailing Information</strong></td>
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<td align="right" class="text1">Address</td>
<td><input name="ADDRESS" type="text" id="ADDRESS" size="30" maxlength="30" /></td>
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<td align="right" class="text1">City</td>
<td><input name="CITY" type="text" id="CITY" size="30" maxlength="30" /></td>
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<td align="right" class="text1">State</td>
<td><input name="STATE" type="text" id="STATE" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Country</td>
<td><input name="COUNTY" type="text" id="COUNTY" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Zip Code</td>
<td><input name="ZIP" type="text" id="ZIP" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Home Telephone</td>
<td><input name="PHONE" type="text" id="PHONE" size="30" maxlength="30" /></td>
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<td colspan="2" class="textbodybold"><strong>5. Work Information</strong></td>
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<td align="right" class="text1">Job Title</td>
<td><input name="TITLE" type="text" id="TITLE" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Company Name</td>
<td><input name="COMPANY" type="text" id="COMPANY" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Address</td>
<td><input name="ADDRESS" type="text" id="ADDRESS1" size="30" maxlength="30" /></td>
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<td align="right" class="text1">City</td>
<td><input name="CITY" type="text" id="CITY1" size="30" maxlength="30" /></td>
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<td align="right" class="text1">State</td>
<td><input name="STATE" type="text" id="STATE1" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Zip Code</td>
<td><input name="ZIP" type="text" id="ZIP1" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Work Phone</td>
<td><input name="W PHONE" type="text" id="W PHONE" size="30" maxlength="30" /></td>
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<td align="right" class="text1">Fax</td>
<td><input name="W FAX" type="text" id="W FAX" size="30" maxlength="30" /></td>
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<tr align="center">
<td height="50" colspan="2" class="text1"><input type="submit" name="Submit" value="Submit" /> <input type="reset" name="reset" value="Reset" /></td>
</tr>
</table>
</form>