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Update your Contact Info

Brock Alumni Relations

Update your Contact Info

First Name: *

Last Name: *

Maiden Name :

Student ID #:

Phone Number: * (xxx) xxx-xxxx

Email Address:: *

Address : *

City: *

Province/State: *

Postal Code: *

Country: *

Alumni Magazine - Surgite

Please send me Surgite by email:

Yes

I do not wish to receive Surgite in any form:

Yes

Alumni Cards

Alumni cards provide Brock grads with access to on-campus services (such as Career Services and Library borrowing privileges) and merchant discounts on travel and leisure activities (such as Via Rail, Canada’s Wonderland and the Royal Ontario Museum).

Please send me my alumni card:

Yes

Career Information

Job Title:

Company Name:

Department/Branch:

Privacy

Brock University protects your privacy and your personal information. The personal information requested on this form is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) for the administration of the University and its programs and services. Direct any questions about this collection to the Office of Alumni Relations – alumni@brocku.ca [1]

Source URL: http://www.brocku.ca/alumni/connect/update-your-contact-info