Alumni Interest Group Request Form

Title/Name of interest group:

Purpose of the group:

Brief description of targeted membership:

Brief description of group's activities:

Frequency of gatherings:

Other useful information:

Primary contact for the group:
    Mailing address:
    Phone number:
    Cell number: 

Contact's preferred method of communication from prospective members (click all that apply): 


Additional online presence (Facebook, website, etc.): 


Web address:  

Services provided by Berry in which we are interested (Check all that apply. See Services Available to Alumni Interest Groups document for more information on these services): 


For additional information, please refer to the Services Available to Alumni Interest Groups document, or contact the Office of Alumni Relations at 706.236.2256, 800.782.0130 or