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 (Last, First and Middle Initial): *
Name used while at Regent:
Street Address: *
City: *
State/Province: *
Zip Code: *
Country: *
Home/Cell phone: *
Work Telephone:
Current Email Address: *
Regent Email Address (if known):
Date Attended/Graduated: *
  * Required fields
    

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