Washburn Law Alumni Association
Membership Form

Please Note

Washburn Law does not share email addresses with third parties without your permission.
(Privacy Policy)

Use this form to join the Washburn University School of Law Alumni Association or to renew your membership for July 2012-June 2013.

NOTE: After you submit this form an acknowledgment page will display. You may remit payment via the methods described on the acknowledgment page (credit card or check).

To complete this form:

TAB moves between fields.
Required fields marked with * .
Text fields show number of characters typed / number of characters allowed.
SUBMIT sends your information.

Your Name

* Title:

* First Name:

Middle Name:

* Last Name:

Suffix:

Nick Name:

Maiden Name:

* Class Of:

Home Address

Street/P.O. Box:

City:

State:

Province:

Country:

Zip/Postal Code:

Phone: Area Code:

Number:

Cell Phone: Area Code:

Number:

E-mail:

Business Address

Position/Title:

Business or Firm Name:

Street/P.O. Box:

City:

State:

Province:

Country:

Zip/Postal Code:

Phone: Area Code:

Number:

Extension:

Fax: Area Code:

Number:

E-mail:

Areas of Specialty / Other Information

Specialty 1:

Specialty 2:

Specialty 3:

Other information you wish to share with us regarding your career, professional or community activities, awards, etc.:

Membership Category

* Please select a category:

FREE - Class of 2012 Complimentary One Year Membership
$25 Annually - Graduating Classes of 2009, 2010, and 2011
$50 Annually - Annual Membership
$1,000 - Life Membership
$1,000 - Life Membership ($250 per year over 4 years)

To receive an e-mail acknowledgment please provide
either a home or a business e-mail address.

Washburn Law Alumni Association Membership Form

Please Note

Washburn Law Alumni Association
Membership Form