<p class="fontlook2">

<p class="fontlook">Please fill out the form below. This is a request for Alumnae registration and will allow you to login to the special alumnae website area. 

<form method="post" action="emailform.pl">
<TABLE>
<TR>
<TD colspan=2><p class="fontlook"><B>Alumnae Information</B></TD>
</TR>
<TR>
<TD><p class="fontlook">* First Name:</TD>
<TD><p class="fontlook"><input type="text" name="fname"></TD>
</TR>
  
<TR>
<TD><p class="fontlook">* Last Name:</TD>
<TD><p class="fontlook"><input type="text" name="lname"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">* Maiden Name:</TD>
<TD><p class="fontlook"><input type="text" name="mname"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">Birthdate:</TD>
<TD><p class="fontlook"><input type="text" name="bdate"></TD>
</TR>
  
   
<TR>
<TD><p class="fontlook">* Graduation Year:</TD>
<TD><p class="fontlook"><input type="text" name="gyear"></TD>
</TR>
  
   
<TR>
<TD><p class="fontlook">* Address:</TD>
<TD><p class="fontlook"><input type="text" name="address"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">* City / * State / * Zip:</TD>
<TD><p class="fontlook"><input size=10 type="text" name="city"> &nbsp;
			<input size=5 type="text" name="state"> &nbsp;
			<input size=8 type="text" name="zip"></TD>
</TR>
  
     
<TR>
<TD><p class="fontlook">* Tel:</TD>
<TD><p class="fontlook"><input type="text" name="tel"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">Fax:</TD>
<TD><p class="fontlook"><input type="text" name="fax"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">Cell:</TD>
<TD><p class="fontlook"><input type="text" name="cell"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">Email Address:</TD>
<TD><p class="fontlook"><input type="text" name="email"></TD>
</TR>
  
   
<TR>
<TD colspan=2><p class="fontlook"><B>Work Information</B></TR>
  
<TR>
<TD><p class="fontlook">Company Name:</TD>
<TD><p class="fontlook"><input type="text" name="company"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">Work Address:</TD>
<TD><p class="fontlook"><input type="text" name="waddress"></TD>
</TR>
  
    
<TR>
<TD><p class="fontlook">City / State / Zip:</TD>
<TD><p class="fontlook"><input size=10 type="text" name="wcity"> &nbsp;
			<input size=5 type="text" name="wstate"> &nbsp;
			<input size=8 type="text" name="wzip"></TD>
</TR>
  
     
<TR>
<TD><p class="fontlook">Work Tel:</TD>
<TD><p class="fontlook"><input type="text" name="wtel"></TD>
</TR>
  
    
   
<TR>
<TD><p class="fontlook">Password:</TD>
<TD><p class="fontlook"><input type="password" name="password"></TD>
</TR>
  
   
<TR>
<TD><p class="fontlook">Receive Newsletter Y/N</TD>
<TD><p class="fontlook"><SELECT NAME="newsletter">
<option value="Yes">Yes</option>
<option value="No">No</option>
</SELECT>
</TD></TR>

</TABLE>  
<input type="hidden" name="type" value="alumnae">
<input type="submit" value="Submit"><BR>
