Northern College of Applied Arts & Technology

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Alumni Information
First Name:	Middle Name:
Last Name:	Name on Diploma (Maiden Name, etc):
Address:	City:
Province/State:	Country:
Postal(Zip) Code:	Phone Number: ()
Student Number(if you remember!):	*Birthday:
*E-mail:	*Northern Program:
*Year of Graduation:	*Campus Location:
Personal Information
Tell us about yourself (interests, associations, etc.), How did you hear about the Northern College Alumni Council and how to register?:

What type of participation in the Alumni Council interests you? (You can select more than one)*
Participating in Events Helping to Organize Events Recruiting Other Alumni Organizing Class Reunions	Serving as an Executive Member Writing Articles for a Newsletter Other
Employment Information
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Company Information
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Confidentiality Statement
The information you have provided on this Alumni Council Registration Form will be used only for the purpose of supporting the activities of the Northern College Alumni Council and Northern College. *Do you give permission to publish the above information? Yes No