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Homecoming Registration

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Fields marked with * are required

Your Information

First Name:	*
Last Name:	*
Maiden Name:
Class Of / Last Year Attended:
Address:	*
City:	*
State:	*
Postal Code:	*
Home Phone:	*
Work/Cell Phone:
Email:

Spouse/Guest Information

First Name:
Last Name:
Alum?	Yes
Class Of / Last Year Attended:

Events and Fees

Option 1 - All Events (Inludes basketball game entrance fee)	@ $50	=$
Option 2 - Friday Only (Feb. 15)	@ $24	=$
Option 3 - Saturday Only (Feb. 16)	@ $28	=$
Alumni Dues	-Select One- Single ($20) Couple ($35)	=$
My Student Scholarship Fund Contribution:		=$
Total:		=$

Bethany University - 800 Bethany Drive - Scotts Valley, CA 95066
(831) 438-3800 Phone · (800) 843-9410 Toll-Free · (831) 438-6104 Fax
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