UCLA Bruin Family Social Registration Form
Thousand Oaks, CA
Friday, November 13 | 6 p.m. PST
The Paddock
1345 E Thousand Oaks Blvd, Thousand Oaks, CA, 91362
Hosted by Jackie Rome, Parent '28
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
10-digit UID (Optional)
UCLA Affiliation (Check all that apply)
*
Parent/family member of a current UCLA student
UCLA Alumnus
Other
Student Name
First Name
Last Name
Student Grad Year
(e.g. 2015)
Your UCLA Grad Year and Degree
(e.g. 1987; MBA '91)
Will you be bringing any guests to the Bruin Family Social?
*
Yes
No
Number of Additional Guests
Please Select
1
2
3
Guest 1 Name
First Name
Last Name
UCLA Alum?
Yes
No
Grad Year and Degree
Guest 2 Name
First Name
Last Name
UCLA Alum?
Yes
No
Grad Year and Degree
Guest 3 Name
First Name
Last Name
UCLA Alum?
Yes
No
Grad Year and Degree
Submit
Should be Empty: