Print and complete this form

_____________________________________________________
ID No.
_____________________________________________________
Name
_____________________________________________________
Address
_____________________________________________________
City/State/Zip
_____________________________________________________
Day Phone Number
_____________________________________________________
Email Address (if applicable)

Major(1)________________ (2) ________________ Minor ______________

Degree _____________ Grad Date ____ /_____ (mo/yr)

Check one of the following:

____ Current Undergraduate/Graduate/Teacher Certification Students $25.00
(New Blugold CareerLink Registrant - continued enrollment for one year following graduation)

____ Alumni $60.00/year (New Blugold CareerLink Registrant)

____ Alumni $50.00/year (Previous Blugold CareerLink Registrant)
(Bachelor, Masters, or Teacher Certification completed)

____ Non UW-Eau Claire Graduate $75.00/year - View job postings online

Make checks payable to: UW-Eau Claire

Forward form and payment to:
Career Services, UW-Eau Claire
P.O. Box 4004
Eau Claire, WI 54702-4004
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FOR OFFICE USE ONLY:

Date Received _____________ Expiration Date ____________ Input ______________