Alumni Registration Form

Please complete the form below to register for alumni database access and to receive a library alumni card. Database access and library borrowing privileges will be authorized once this information (i.e. graduation date) is verified.

Please allow five (5) business days for verification and approval.

Name (first, middle initial, last): *
Name used while at Regent:
Address: *
City: *
State/Province: *
Zip Code: *
Country: *
Home Telephone: *
Work Telephone:
Date degree awarded:
(must be Regent Univ. graduate)
Email Address: *
  * Required fields

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