Alumni Card Request Form

Take advantage of your status as a Western alumna or alumnus and request your free Western Alumni Card today!

*First name:
*Current last name:
*Last name at the time of graduation:
Student number (optional, 9 digits):	[My student number is less than 9 digits. What do I do?]
*Degree:
*Year of graduation:
*Email:
Phone number:
Phone type:

Mailing Address - please provide the address to which your Western Alumni Card should be mailed.
*Street 1:
Street 2:
*City:
*Prov/State:	Enter your province\state\region below
*Country:
Postal/ZIP code:
Reset

* indicates required field

Western University, Department of Alumni Relations & Development
Westminster Hall, Suite 160
London, Ontario, Canada, N6A 3K7
Tel: 519-661-2199
Toll-free: 1-800-258-6896
alumni@uwo.ca

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