First Name:
Maiden Name:
Current Last Name:
Street Address (line 1):
Street Address (line 2):
City/Town, State, Zipcode:
Phone Number(s):
Email Address:
Occupation:
Single/Married:	Single Married
Spouse's Name (if married):
Date Married:
Child/Children's name(s) and Age(s):
Can we post your information on our website?	YES NO
What information may we post on our website?	address phone number email address your picture
Can we add your email address to our listserve? (The listserve is for getting information out and keeping an updated list for our Class of 1982.)	YES NO
Do you have any other information to share? Any comments?

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