Contact Information
For additional information on any program offered through Northern College's School of Mining Engineering Technology
contact the Program Coordinator at mining@northern.on.ca
Haileybury School of Mines Alumni Registration
Alumni Information(*Indicates a required field)
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:
S.I.N.:
*E-mail:
*Northern Program:
*Year of Graduation:
Personal Information
Tell us about yourself (interests, associations, etc.):
What type of participation in the Alumni Association interests you?
(*You can select more than one)
Participation in Events
Helping to Organize Events
Recruiting Other Alumni
Organizing Class Reunions
Serving as Executive Member of the Alumni Association
Writing Articles for Alumni Newsletter
Other
Employment Information
*Are you working in a related field?
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* Occupation/Position:
Company Information
Name:
Phone Number: ()
Ext.
Confidentiality Statement
The information you have provided on this Alumni Association
Registration Form will be used only for the purpose of supporting the activities of the Northern College Alumni
Association and Northern College.
*Do you give permission to publish the above information?
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