Identification Information

Student ID Number: (if known)
First Name:
Last Name:
Middle Name Former Last Name
Date of Birth Gender

Contact Information

Street Number, Name Apartment
City Postal/Zip Code
Province/State Country
Email Address International Phone
Phone (including area code) Business Phone
-- --ext

Graduation Information

Program Graduated From Year Campus

Employer Information

Employer Name Employer Address

As you may know, the federal government has passed legislation to help Canadians avoid spam and other electronic threats. Under the new law, e-mail recipients must give their express consent to receive messages.

In an effort to ensure the accuracy of our e-mail list and in keeping with the spirit of this legislation, we are asking you to confirm your desire to continue receiving mailings from Confederation College Alumni Services.

YES I would like to receive mailings from Confederation College Alumni Services