Guevarian Membership Application

Please fill out the form below to become an official member of the Guevarian Alumni Network.

Information shall be kept CONFIDENTIAL and shall NOT be disseminated for telemarketing or any form of misuse, abuse, or violation of personal privacy and security.

Thanks.

Membership Form

Please provide Formal Given Names Only. No Nicknames Please.

First Name

Maiden Name (if applicable) FOR MARRIED FEMALES ONLY	FOR MARRIED FEMALES ONLY

Last Name

Street
City/Town
State/Province
Zip Code
Country

Class Year (or member of)
Class Section

Email
I want my email linked so that folks can send me messages directly:
	Yes No

Homepage
Home Phone:
Work Phone:

How did you hear about our group?

Please allow time for your listing to appear.

Thanks!