WAA Alumni Advisory Council: Request for Information

Thank you for serving on the Wisconsin Alumni Association (WAA) Alumni Advisory Council. Your passion for the UW and insights as a proud alum are welcome additions to the council. If you have any questions or are unable to complete the submission process, please contact Andrea Berns.

To provide timely communication with you and ensure that WAA’s marketing and communications division has up-to-date information to craft any needed media announcements regarding the council, please complete the following form. Also, note that any files you upload may be shared outside of the organization for marketing purposes.
Email*
Phone number*
Upload your photo/professional head shot.
Max. file size: 2MB
Upload your professional bio or directions to your online bio.
Max. file size: 2MB
Full name*
First*
Last*
UW degree and graduation year*
Nickname or preferred name
Spouse/partner name
First
Last
Spouse/partner degree, graduation year, and school attended
Your preferred mailing address is your:*
Home residence*
Street Address*
Address Line 2
City*
State / Province*
ZIP / Postal Code*
Country*
Occupation*
Business name
Business address
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country
Do you have an alternate or seasonal address?
- Yes
- No
Alternate/seasonal address
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country
Alternate/seasonal phone number
Alternate/seasonal email
Would you like your assistant copied on emails/correspondence?
- Yes
- No
Assistant's name
First
Last
Assistant's email
Assistant's phone number
List areas of interest, influence, and/or affiliation with UW–Madison (such as boards of visitors, advisory boards, committees, career/mentoring programs, clubs, etc.)
(maximum 1000 characters)
List any dietary restrictions or preferences you have.
(maximum 1000 characters)

Please complete all required (*) fields and correct any error(s) above.