Information About Me

 
17% of survey complete.

* Salutation:

* First Name:

* Maiden Name (if applicable):

* Last Name:

* Preferred Name:

* Address Line 1:

* Address Line 2:

* City:

* State/Province/Region:

* Zip/Postal Code:

* Country:

* Preferred Phone:

* Type:

* Secondary Phone:

* Type:

* Primary Email:

* Secondary Email:

* Relationship to Butler (select all that apply):

* If alumnus/a, please indicate graduation year:

* Please add any personal updates that you would like to share with the University or your classmates. This may include professional accomplishments, community and volunteer activities, recent marriage, or addition to your family. You may choose to have this information included in our Class Acts section of Butler Magazine.

* Optional: Upload a photo for inclusion with your Class Act submission. Please know that not all photos will be used in the publication of Butler Magazine.

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