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Please complete the following:

Name:      Maiden Name: 

Address: 

City/State/Zip: 

Telephone (Please indicate area code): 

E-mail address: 

Spouse's name: 

Number of children:      Ages of children: 

Number of Grand-children:      Ages of Grand-children: 

Number of Great-grandchildren:      Ages of Great-grandchildren: 

Are you currently married?:      Date of current marriage?: 

How many times have you been married?: 

Did you serve in the military (please indicate branch and length of service)?: 

Please tell us something about your jobs/career:

Are you on Facebook?: 

Are you on Twitter?: 

Are you on Snapchat?: 

If you received your diploma in June 1969, please leave this blank. If you were in our class but received your diploma at another time, please indicate month and year: 

Please indicate any other information you would like to include such as accomplishments, places lived, etc: