GEORGETOWN COLLEGE

Alumni Information Request Form

Please Print and Mail Completed Form to the Development Office
400 East College Street; Georgetown, KY 40324
502-863-8041

Name:____________________________________ Date:_________________________

Address:___________________________________ Phone Number:________________

Name of Organization/Department:_________________________________________

Purpose:_______________________________________________________________
                    (If for fundraising, please complete Fundraising Approval Form)

Request: Labels_____ Lists____    Date Needed: _____________________________

Specifics of request:
 Join Husband/Wife?             Yes___         Example: Mr. and Mrs. John Doe

                                                 No____        Example: John Doe  One to each person in household                                                                                        Jane Doe

Class Years to include: ______________________       
Formers____    Bachelor's Degree_____    Graduate/Master's Degree_____
Majors:_____________________________________________________________________
Minors:_____________________________________________________________________
Involvements:________________________________________________________________
Other information:____________________________________________________________

Alpha order___         Zip Order____ (for bulk rate mailing)

I understand that the information I obtain is confidential and is not to be used for any purpose other than that which I have specified.

Signature:__________________________________________________

Development Office: Approval Date:______________________ By:_________________________