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Advocates Enrollment Form
  
 
PLEASE COMPLETE THE FIELDS BELOW:
Name:
Are you an alumnus/a:
Grad Year:
Major:
Address:
City, State, Zip:
Phone (Work):
Phone (Home):

ORGANIZATIONS / CONGREGATIONS
Job Title:
Employer:
Employer Address:
Employer City:
Congregation (optional):
Church Address (optional):
Church Phone (optional):
Church E-mail (optional):
Pastor Name (optional):
Youth Leader Name (optional):

INTERESTS / SUPPORT
What are you most excited about with the Wartburg Advocates program:
About what would you like to know more:
How can we better support you:

Please enter your e-mail:    

You will be redirected to the Wartburg Advocates page once your information is sent.

 


Wartburg College - 100 Wartburg Blvd. - Waverly, IA 50677 - (800) 772-2085