Alumni Application Form

Please provide the Alumni's information. Please use your information or the recipient who will receive the Diploma and membership as a gift.

Paypal Address used to purchase membership:

Is this a gift for someone else? Yes .

Recipient/Alumni's User name (required)

Recipient/Alumni's Email Address (required)

Name on Diploma

Recipient/Alumni's First Name (required)

Recipient/Alumni's Last Name (required)

Studies at Miskatonic University:

Year Graduated:

Proof you are not a web-bot...or even worse - a shuggoth!
25 + 25 = ? 

You agree to the terms and conditions Yes, I agree.