JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
E-Club Letterwinners
Complimentary Membership Registration
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Last Name (Maiden Name)
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Class Year (Bachelors)
*
Your answer
Class Year (Masters/Doctorate)
Your answer
Degree(s)
Your answer
Sport(s) Played
*
Your answer
Year(s) Played
*
Your answer
Street Address
*
Your answer
Street Address 2
Your answer
City
*
Your answer
State / Province
*
Your answer
Zip Code / Postal
*
Your answer
Country
*
Choose
United States
Canada
Other
Phone Number (including Area Code)
*
Your answer
I am interested in donating to the E-Club and/or my sport.
Yes
No
Maybe
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Eastern Michigan University.
Report Abuse
Forms
