Long Beach City College Alumni Association

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Annual Membership Form

If 2009 graduates join no later than October 1, 2009, their membership is free.
First Name
Last Name
Maiden Name
Spouse
Spouse's Maiden Name
Phone Number
E Mail Address
Optional	Tell Us about Yourself
Business Name
Street Address
City
State
Zip
Business Phone Number
Profession
Position/Title
Dates Attended LBCC
Major
Degree Earned
If you continued your education, at what institution(s)
Date Spouse attended LBCC
If your spouse continued education, at what institution(s)
Are you or have you been Staff/Faculty?
If spouse or other family members attended LBCC are deceased please indicate their names for our records (thank you)
Friends of the College?
I would like to help support the LBCC Alumni Association Scholarship Fund with additional donation of
I would like to establish a Foundation Scholarship in the Name of

LBCC Alumni Association
4901 East Carson Street, Mailstop B12
Long Beach, CA 90808
Telephone: (562) 938-4203

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