*Name (First, Last, Maiden)

*E-Mail Address

*Address (Please include City, State and Zip Code)

*Phone Numbers (Day & Night)

Fax Number

Did you attend Cleveland State? If yes, list years and any varsity sports played.
Yes
No

Employer

Would you like to receive more information on specific Cleveland State sports? If yes, indicate which sport(s).
Yes
No

How many Cleveland State basketball games do you attend each year?

What do you enjoy most about Cleveland State basketball games

Are you a member of the Viking Club?
Yes
No