Class of 76 Email List Registration Form
Fill out this form to get on our mailing list.

 
Please provide the following  information:
(This information will ONLY be used to contact you with reunion information and not used for any advertising.)
Your Name: 
 *First Name  Middle Name or Initial *Last Name
Were you known 
by another name 
in High School?
 Former First Name Former Middle Name
or Initial		 Former Last Name

 
Your Address: 
 Street Address
City State
Zip Code Country
Home Phone Number: 
 * E-Mail Address: 
 Do you prefer 
we contact you by: 

Marital Status: 
Spouse's or Significant Other's Name: 
Number of Children: 
Children's Names: 

 
Your Occupation: 
Company Name: 
Work Phone: 
Extension: 
Please type any additional comments or requests here:

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