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Town & Gown Affiliates October Event

Tuesday, Oct. 12
6 p.m. PT

Live Via Zoom




Required fields are indicated with an asterisk (*).
RSVP Information
Registration
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Event Admission - Complimentary - No Donation Required
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Contact Information   

Personal
Title:
* First name:
  Middle name:
* Last name:
  Suffix:
UCLA graduation year(s):

Contact Information
* Street:
 
U.S. Addresses  
*   City, State, Zip:
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
  Country:
* This address is my:
* Home telephone:
Business telephone:

* E-mail address:
* This e-mail is my:

Additional Information
 
 Job Title:
 Company Name:
 Pronouns:
 * UCLA Affiliation:
Guest Information
The following fields are required for all of your additional guests.
If you are the main registrant, no need to include yourself below as we have your information above.

Your First Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Second Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Third Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Fourth Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Fifth Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Sixth Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Seventh Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Eighth Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:
Your Ninth Guest:
 * First Name:
 * Last Name:
 * Email address:
 * Alumnus/a of UCLA?:
 UCLA graduation year:

 
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