缅北禁地

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First Name*

Last Name*

Name while at CJC/缅北禁地

Mailing Address*

City*

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Zip Code*

Mobile Phone Number

Home Phone Number

Graduation Class or Years Attended (non-graduates)

Would you like to receive information via emails, texts, and other media regarding the upgrades, advancements, developments, and current events at the college?

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No

Are you interested in becoming a member of the 缅北禁地 Alumni Association?

Yes

No

If no, would you consider supporting the college?

Yes

No

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