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Alumni Contact Directory -Form Fill

Section One
Q1

Today's Date

Month
Q2

Today's Date

Day
Q3

Today's Date

Year
Q4

Classmate Name

First Name
Q5

Classmate Name

Last Name
Q6

E-mail
Q7

Verify E-mail
Q8

Address

Street Address
Q9

Address

Street Address Line 2
Q10

Address

City
Q11

Address

State / Province
Q12

Address

Postal / Zip Code
Q13

Address

Country
Q14

Phone Number

Phone Number
Q15

Spouse/Partner

First Name
Q16

Spouse/Partner

Last Name
Q17

Number of Children
Q18

Number of Grandchildren
Q19

Please tell us of your achievements, hobbies, travel, vivid memories of your time at LCHS, ambitions, and any other information you would like to share with former classmates & faculty members.
Q20

I give my permission to the Reunion Committee of LCHS Class of 1963 to include the above information in the Class Directory. This information will not be used for any other purpose and will not be distributed to anyone other than classmates or teachers.
Q21

Do you plan on attending our 50th reunion?
Q22

I give my permission to the Reunion Committee of LCHS Class of 1963 to include the above information in the Class Directory. This information will not be used for any other purpose and will not be distributed to anyone other than classmates or teachers.