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Personal Information

Name

Title

First

Last

Suffix

Maiden Name

If applicable.

Birthdate

L Number L

Email Contact

Email Contact
Email Address Email Type

Home Phone

Mobile Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Class Year

College/School/Institute of Study

Spouse's Name:

Title

First

Last

Suffix

Is spouse an alum?

Yes

Spouse's Class Year

Spouse's Birthdate

Children's Names & Birthdates

Name	Birthdate	Operations
Name	Birthdate

more child

Ethnicity

Are you a veteran?

Yes

Business Information

Position/Title

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone

Fax

Industry

Bison Notes

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Some of your info (job title, employment) may be appropriate content for Bison Notes, the class notes section of the Lipscomb NOW magazine. Please indicate if you agree to let your submission be considered for publication in Bison Notes. No personal contact info such as address, phone or email will be published in Bison Notes.