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Northwestern University School of Law Class Agent Program

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1. Name

Name   Yes
No

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2. Degree and Year

	Degree
Select one:	JDJD-MBAJD-PhDJD-LLM in International Human RightsTwo-year JD for International LawyersLLMLLM/KelloggLLM/TaxExecutive LLM/MadridExecutive LLM/SeoulExecutive LLM/Tel AvivSJDMSJ-MSL Degree and Year   Select one:   Degree	19591964196919741979198419891994199920042009

My preferred contact information is below:

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3. Address (Home or Work)

Select one	HomeWork Address (Home or Work)   Select one

4. Address (Home or Work)

Address (Home or Work)   Address1
Address2
City
State
Zip

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5. Email address

Email address

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6. Phone (Home/Work/Mobile)

Select one:	HomeWorkMobile Phone (Home/Work/Mobile)   Select one:

Phone Number

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7. Are you interested in becoming a volunteer Class Agent?

Are you interested in becoming a volunteer Class Agent?   Yes, I agree to serve as a Class Agent. No, I am unable to serve as a Class Agent at this time.