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Class Year

Major
Full Name
(while attending Lakes Region CC)
Maiden Name
Current Name
(if different from above)
Address
(City, State, Zip)
Phone
E-mail
Further education after
Lakes Region CC
Your occupation/position
I am interested in participating in future planning for the association
Yes No
I am interested in participating in lectures or workshops
Yes No
I am interested in receiving notices about upcoming events
Yes No
Your story since Lakes Region CC &
Your ideas about types of activities you'd like us to offer