Alumni Impact Survey

Please complete this form accurately as the information you provide is used to update our databases. Your answers to the questions with an asterisk (*) are published in the alumni directory on the LR website. (If you do not want to use your business contact information, simply complete with the information you do want published.)   1. Name*         2. Title*         3. Company*         4. Business Address*         5. City*         6. State*         7. Zip Code*         8. Business Telephone*         9. Email Address*                 Please only fill out your home address information if it has changed in the past year.       10. Home Address         11. City         12. State         13. Zip Code         14. Home Telephone         15. Cell phone         16. Residency   -- None -- City of Racine Elmwood Park Wind Point Northbay Caledonia Sturtevant Mt Pleasant Kansasville Union Grove Waterford Other