Alumni Membership Application

To enjoy all the benefits as a lifetime member of the BUCKS Alumni Association, please complete and submit the following information to:

Bucks County Community College
c/o Alumni Association - Tyler Hall
275 Swamp Road
Newtown, PA 18940

Lifetime members of the Alumni Association include every person who graduated from BUCKS in either a recognized degree or certificate program, and any former student who has completed 30 or more credits in either a recognized degree or certificate program. Your official membership card will be issued and mailed to you within two weeks.

* Required Fields

Personal Information:
Mr. Mrs. Miss Ms. Dr. Other
*First Name:	MI	*Last Name:
*Address:

*City:

*State:

*Zip Code:

Country:

Home Phone:

*Email Address:

*Class Year:

Student Number (if known):

Maiden Name:
Spouse's Name (if applicable):

Please indicate the following about your education at Bucks:
Degree or Certificate Program:		Credits Completed:

Additional Educational Information:
School(s):
Degree(s):

Activities/Interests:

Career Information:
Occupation:		Position:

Company Name:
Business Address:

City:

State:

Zip Code:

Country:

Business Phone:

FAX:

Additional Comments: