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Northern Illinois University

College of Business - NIU

NIU Rockford Club Application

Please complete and submit the following online application. If you have any questions regarding this form or the NIU Rockford Club, please contact businessalumni@niu.edu.

PERSONAL INFORMATION:

First Name:   M.I.:   Last Name:
Preferred "Nickname":
Home Address:
City:
State/Province:   Postal Code:
Country:
Home Phone:
Email:

EDUCATION:

1st Degree - Institution
Degree
 Year
 Major
2nd Degree - Institution
Degree
 Year
 Major
3rd Degree - Institution
Degree
 Year
 Major

COMPANY INFORMATION:

Company Name:
Company Description:
Company Web Address:
Position Title:
Work Address:
City:
State/Province:   Postal Code:
Country:
Work Phone:
Fax:
Assistant Info:
Preference for mailings: home address   business address
Please type the letters you see in the box to the right: