Contact Information Request Form

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BIOGRAPHICAL
Name :
Ethnic Background:
Gender :		Select Male Female
Address :
Phone Number :
Email Address :
Primary Contact:		E-mail Address Mailing Address Phone Number Fax Number
EDUCATION
College :		Select Calhoun Saybrook Silliman Timothy Dwight Ezra Stiles Morse Branford Jonathan Edwards Berkeley Trumbull Pierson Davenport	Year:
Undergraduate Degree :
Other Degrees :
What Latino Organization Were You Involved With?
EMPLOYMENT
Company Name :
Title :
TELL US ABOUT YOURSELF Please include any information you'd like to share with us! Tell us about your family, any current ties with Yale, etc.
Yes	No	I would like to receive more information about the Yale Latino alumni association
Yes	No	I would like to get involved in the development of the Yale Latino alumni association
Yes	No	I would like to be added to the Yale_Latinos email listserv
Yes	No	I would like to complete the recent survey and add my recommendations to the development of the Yale Latino alumni association
Yes	No	I am not interested in receiving further correspondence regarding Latino alumni activities at Yale

Also, please register with the Association of Yale Alumni (AYA) at: http://www.alumniconnections.com/yale