| *Full Name: |
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| Student Name: |
Year: |
| I am a: |
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| Preferred Email: |
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| Please contact me at my: |
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| Home Address 1: |
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| Home Address 2: |
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| City: |
State: Zip: |
| Country: |
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| I am interested in participating in the following initiatives: |
Parent Network
Parents Fund
Ask a Parent
Career Services
Parents Orientation
Inside CMC Day/On Campus Day
Regional/Local Host |
Are you willing to host a parent or alumni event in your home,
company conference room, or club facility
Yes No |
If so, please describe the site and the number of people it may accomodate
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