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***Please read Disclosure and Acknowledgement of Consent at the end of this form.***

Please read the University of Regina Change of Name Policy prior to submission of this form.

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Contest!  
Updating your information automatically enters you into the "Stay Connected" contest. If you refer an alumnus to update their information, you will receive two additional entries when they do so.

How did you hear about the contest?
Dispatch newsletter
Degrees Magazine
Referred by (name of alumnus):
Other:

Services/Signup  
Email For Life (More Information)
(Not available for alumni who are current U of R employees)
Dispatch newsletter (More Information)


Your Information  
Full Name: *
Maiden Name: *
Marital Status:
Spouse Full Name:
Is your Spouse a UofR Grad?
Degree: *
Student Identification Number:
Other Post-Secondary Info:
Institution:
Degree conferred and year of graduation:


Home Information  
Street Address: *
City: *
Province/State:
Country:
Postal Code: *
Home Phone: *
Home Fax:
E-Mail: *


Business Information  
Name of Company:
Title of Occupation:
Street Address:
City:
Province/State:
Country:
Postal Code:
Business Phone:
Business Fax:
Business E-Mail:


Contact Preferences  
Please identify whether you would prefer to receive contact from the University at your home or business.
Mail: Home or Business
Phone: Home or Business
E-Mail: Home or Business


Additional Information  
Any additional information Births/ Anniversaries/ Professional news you would like to share with the University or for use in University of Regina publications:
 
The University of Regina maintains a database of all students, alumni and friends which is used for University alumni relations purposes, information and activities including, but not limited to, sending you: Degrees; electronic newsletters; invitations to special events and activities; news about the University; and requests for support. The database is also used by third party business partners of the University and the Alumni Association which offer benefits to alumni and students through insurance, credit card, financial and other services.
 
You acknowledge and consent to the use and disclosure of database information relating to you (such as your name, mailing address, phone number, degree(s) and year of graduation) for the aforementioned purposes unless otherwise indicated.
 
If you do not want to receive these materials or do not consent to the disclosure and use of such database information by the University of Regina, the University of Regina Alumni Association or related third-party business partners please indicate below:
I do not wish to be contacted by:
the University of Regina
the University of Regina Alumni Association
I do not wish to receive any mailings or be contacted by third-party business partners of the University or the Alumni Association (i.e. insurance or affinity card program information) and do not consent to the disclosure of any personal information to such third parties.
 
This Disclosure and Acknowledgement of Consent is provided pursuant to the Personal Information Protections and Electronic Documents Act, S.C. 2000, c.5



 
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