<h2><a href="http://siuealumni.wildfire.net/wum5/viewer?ACTION=DrillDown" target="_blank">Join Now!</a> | Join by Form | <a href="/id0904f67a8056c086">Membership Benefits</a></h2>&nbsp;&nbsp;<table> <tbody> <tr> <td height="245" valign="top" width="505"> <table border="0" width="460" cellspacing="0" cellpadding="0"> <tbody> <tr> <td> <h3><!-- InstanceBeginEditable name="bodytext" -->Become A Member : Printable Membership Form</h3> <p class="textbody">To join STAT, fill out and print this form and mail it along with your check to:</p> <blockquote> <p class="textbody"><strong><span class="textbodybold">STAT<br /></span></strong><span class="textbodybold">C/O SIUE Alumni Association</span><br />Campus Box 1031<br />Edwardsville, IL 62026-1031</p> </blockquote> <p class="textbody">You may also stop by the office on the first floor of Birger Hall to drop off your application.</p> <form name="form1" action="" method="post"> <table border="0" width="455"> <tbody> <tr> <td class="head2a" colspan="2"> <h3 align="center">Printable Membership Form</h3> </td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>1. Your Information</strong></td> </tr> <tr> <td width="127" class="text1" align="right">Last Name</td> <td width="318"><input name="textfield" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">First Name</td> <td><input name="textfield2" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Banner ID #</td> <td><input name="textfield3" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Maiden Name</td> <td><input name="textfield4" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Title Select title<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />Mr. <input name="checkbox5" type="checkbox" value="checkbox" /> Mrs. <input name="checkbox6" type="checkbox" value="checkbox" /> Ms. <input name="checkbox7" type="checkbox" value="checkbox" /> Miss. <input name="checkbox8" type="checkbox" value="checkbox" /> Dr.</td> </tr> <tr> <td class="text1" align="right">Current Grade Level<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />Fresh <input name="checkbox5" type="checkbox" value="checkbox" /> Soph <input name="checkbox6" type="checkbox" value="checkbox" /> Junior <input name="checkbox7" type="checkbox" value="checkbox" /> Senior <input name="checkbox8" type="checkbox" value="checkbox" /> Grad</td> </tr> <tr> <td class="text1" align="right">Expected Graduation Date<br /></td> <td><input name="textfield5" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Major(s)</td> <td><input name="textfield5" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Previous SIUE Degree(s) and Graduate Date(s) (if applicable)</td> <td><input name="textfield8" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">E-mail</td> <td><input name="textfield7" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="text1" align="right">T-Shirt Size<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />S <input name="checkbox5" type="checkbox" value="checkbox" />M <input name="checkbox6" type="checkbox" value="checkbox" />L <input name="checkbox7" type="checkbox" value="checkbox" />XL <input name="checkbox8" type="checkbox" value="checkbox" />XXL</td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>3. Spouse Information</strong></td> </tr> <tr> <td colspan="2"> <table border="0" width="442"> <tbody> <tr> <td valign="top" width="31" align="right"><input name="checkbox9" type="checkbox" value="checkbox" /></td> <td valign="top" width="429" class="text1">Yes! My spouse/domestic partner is current student.</td> </tr> <tr> <td valign="top" width="31" align="right"><input name="checkbox9" type="checkbox" value="checkbox" /></td> <td valign="top" width="429" class="text1">Yes! My spouse/domestic partner is an alumna/us.</td> </tr> </tbody> </table> </td> </tr> <tr> <td class="text1" align="right">Last Name</td> <td><input name="textfield" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">First Name</td> <td><input name="textfield2" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Middle Name</td> <td><input name="textfield3" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Maiden Name</td> <td><input name="textfield4" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Title Select title<br /></td> <td class="text1"><input name="checkbox4" type="checkbox" value="checkbox" />Mr. <input name="checkbox5" type="checkbox" value="checkbox" /> Mrs. <input name="checkbox6" type="checkbox" value="checkbox" /> Ms. <input name="checkbox7" type="checkbox" value="checkbox" /> Miss. <input name="checkbox8" type="checkbox" value="checkbox" /> Dr.</td> </tr> <tr> <td class="text1" align="right">SIUE Current Grade Level</td> <td><input name="textfield5" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">Banner ID #</td> <td><input name="textfield5" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">SIUE Graduation Year(s)</td> <td><input name="textfield5" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">SIUE Degree(s)</td> <td><input name="textfield8" maxlength="30" size="30" /></td> </tr> <tr> <td class="text1" align="right">E-mail</td> <td><input name="textfield7" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="textbodybold" colspan="2"><strong>4. Mailing Information</strong></td> </tr> <tr> <td class="text1" align="right">Address</td> <td><input name="textfield62" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="text1" align="right">City</td> <td><input name="textfield63" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="text1" align="right">State</td> <td><input name="textfield64" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="text1" align="right">Zip Code</td> <td><input name="textfield66" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td class="text1" align="right">Home Telephone</td> <td><input name="textfield67" maxlength="30" size="30" style="BACKGROUND-COLOR: #ffffa0" title="Your Google Toolbar can fill this in for you. Select AutoFill" /></td> </tr> <tr> <td height="50" class="text1" colspan="2"><input name="reset" type="reset" value="Reset" /></td> </tr> </tbody> </table> </form> </td> </tr> </tbody> </table> </td> </tr> </tbody></table><!--EndFragment-->