Alumni Membership Form - Payne Theological Seminary

Graduation Year
First Name*
Last Name*
Birthdate*
MM slash DD slash YYYY
Spouse's First Name
Last Name
Spouse's Birthdate
MM slash DD slash YYYY
Anniversary Date
MM slash DD slash YYYY
Street Address*
Address Line 2
City*
State*
Zip Code*
Phone*
Email*
Church
Position at Church
Employer
Hometown
College
Military
Hobbies/Interests
Committee
- Would you be interested in serving on a committee?
Comittees
Coordinator
- Would you be interested in serving as an Alumni Coordinator for your district or region?
Volunteer
- Would you be interested in volunteering?
Volunteer Areas
What alumni activities would interest you?
Other Activities
Comments, Suggestions, Ideas
Life Updates
How do you want to pay for your membership?
Membership Quantity*
Price: $100.00
You can mail in your dues made payable to PAYNE ALUMNI ASSOCIATION, 1250 S. Hawkins Ave., Akron, Ohio, 44320
Upload a head shot photo for your Alumni Passport
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Total
$0.00
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