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Governors State Alumni Association Membership Form

*Alumni Name:

 

Name on Credit Card if different:

*Home Address:

City: 

 

State:


ZIP Code: 

 

*Phone: 

  Phone Type:  

 *Email: 

Company Name: 

Title: 

Company Address: 

My Employer may match this gift:  

 Select your membership category as designated below:

$ Annual Premium Membership ($50.00 minimum)

$ Life Membership ($650.00)

I would like to make an additional donation to support students scholarships:

$ Alumni Association Scholarship Honoring Rosemary Hulett

$ Freshman Scholarships

*Total donation  $

Please make my gift Anonymous

Once you hit "submit" below, you will be redirected to the Governors State University Foundation on-line donation form through Touchnet, our on-line secure payment provider. 

Pop-up blocker MUST be disabled to complete the donation.  


Any questions please call (708) 235-7559.