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(*denotes required information)

Name as it appears on Credit Card
*Salutation:
*First Name:
Middle Initial:
*Last Name:
Maiden Name:
Suffix:
*Social Security #:
privacy statement
*Year of Graduation:
-or-   *# of Credits Completed
(minimum 30 credits)
:
Curriculum:

Billing Address
*Street:
*City:
*State:
*Zip:
*Phone:
*Email:
Matching Gift Program
(employer matches your donation)
Employer:
Job Title :
Employer Address:
Business Phone:
(if applicable)
*I wish to join the QCC Alumni Association or renew membership:
Free (new graduate)
*Must apply within the first year of graduation
$25 regular membership
$100 associate membership

$125 regular membership + one associate membership

Payment Information :
*Card Type:
*Card Number:
*CV V Number:
*Card Expiration:
(mm/yy)
Additional Contributions :
I would like to make an additional contribution to the Queensborough Community College Fund for Special Projects and Scholarships
Additional Contribution:
$500
$250
$100
$50
$25
Other ($25 or more)
$
I would like to participate in the College’s special project to raise funds and become a part of its history by purchasing a brick inscribed with my name and incorporated into the “Alumni Walk” on campus. Please send me a Brick Reservation Form.
 

 

  Alumni