Name

Street Address

City

Zip Code

State Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

EMail Address

Married? yes no

If 'Yes' Spouses Name and Occupation

Do You Have Children? children grand children great grandchildren

Your Occupation

Hobbies/Interests

Will you be attending our 50th Reunion on October 2, 2009? yes no maybe

Will you need a room reserved at the hotel? yes no

If 'Yes' how many nights?

Will you be attending our “Day in Livingston”? yes no maybe

Will you be bringing your spouse/significant other? yes no

Do you have any interest in going on a cruise? yes no maybe

What would you like to do at your reunion? We are open to suggestions

To help us find you if you get “lost”, can you provide us with a name of a sibling/friend? Name: Phone: DOB: Address: Email Address:

AND, it’s helpful to know what states you have lived in

= Required