Class of '76 Registration Form

Please fill in all of the fields below. This information will be used strictly by the reunion committee for the purpose of contacting you when we have the details.

We are also planning on creating a class directory that will be available only to all registered classmates. Only the information you approve will be added to the class directory. Your information will not be given to anyone without your permission, nor will it be published on the internet.

Name:
     May we publilsh your name in the class directory?
Yes     No
Address Line 1:
   May we publilsh your address
in the class directory?
Yes     No
Address Line 2:
City:
    State:    Zip:
Home Phone:
   May we publilsh your phone number(s) in the class directory?
Both    Home  
Work   None
Work Phone:
  
Home Email:
   May we publilsh your email 
address in the class directory?
Both    Home  
Work   None
Work Email:
Spouse:
   May we publilsh your family infor-
mation in the class directory?
Yes     No
Children:
  

Your Story:
(Anything you'd like to say about the past 25 years)

   May we publilsh your story
in the class directory?
Yes     No

Would you like to help with the preparations for the reunion?    Yes     No

If so, in what area(s) would you most like to help:

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