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Name Maiden Name Street address Address (cont.) City State/Province Zip/Postal code Country Home Phone E-mail Home Page Class Year Select "No" to each of the following that you do not want listed on the web site. Please fill in all the information above so we may inform you of Alumni events. List Address Yes No List Phone Yes No List Email Yes No The following information will help us in the event you move. This information is not listed on the web site, except in the event they too are Alumni and have sent us information. Secondary Contact (usually family member or friend) Contact Phone Additional Comments Comments