FGCU Alumni Association -- Office of Alumni Relations
Alumni Association Membership & Brick Paver Order Form
Phone (239) 590-1016
AlumniRelations@fgcu.edu
Thank you for your membership. Please fill in all fields. You will receive an email confirmation upon submission.

Contact Information
First Name:
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Last Name:
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Middle Initial:
Maiden Name:
Email
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Address:
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City:                 
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State:

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Zip:
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Home Phone:
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Employment Information
Employer:
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Job Title:  
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Phone:
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Email:
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Address:
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City:    
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State:
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Zip:

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Degree(s) Earned at FGCU
Degree 1:    Awarded in Year:   Month
Degree 2:    Awarded in Year:   Month


If you purchase a Life Membership, a Brick Paver is Free!

Please select the type of membership you want to apply for:
Annual
Life
 
$40.00 $400.00 Individual alumna/alumnus membership
$50.00 $600.00 *Joint-alumna/alumnus & person who resides at the same address
$50.00 $700.00 Friend of the university (non FGCU graduate)
$65.00 $1,000.00 *Joint friend & person who resides at the same address

* Joint Member's Information
First Name:    Last Name:  
Address:   City:  ST:
 Zip:   Email:    Phone:

*A Brick Paver is free when you purchase a Life Membership
Brick # 1 (limit 15 characters per line with spaces):
Line 1:
*Brick Paver Program
Detailed information available HERE
Line 2:
Line 3:

This is a secure site. Information provided to Alumni Relations will NOT be distributed outside of this office.


Please charge the membership dues to my:
Account #:
  Expiration Year:     
  Expiration Month:  
Use the contact information provided above
Use the contact information provided below
First Name :     Last Name:
Address:       City:   
State:          Zip:
   
                  

 


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