REGISTRATION FORM

Please help us keep our records up to date.

Name___________________________________________________________________
Address_________________________________________________________________
City______________________ State________ Postal Code_______________________
New Address?

____Yes

____No

Phone__________________________ Email___________________________________
Anniversary_____________________
Family Member Information
Name
Birthday
Interests/Hobbies
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________
4.______________________________________________________________________
5.______________________________________________________________________
6.______________________________________________________________________
7.______________________________________________________________________
8.______________________________________________________________________
Additional Information
Would you be willing to help in planning a future reunion? ___Yes ___No ___Maybe
Would you be interested in having a fundraiser? ___Yes ___No ___Maybe
Would you be interested in a family directory? ___Yes ___No ___Maybe
Would you be interested in a family cookbook? ___Yes ___No ___Maybe
Would you be interested in a family newsletter? ___Yes ___No ___Maybe
Any additional comments___________________________________________________
________________________________________________________________________
________________________________________________________________________
Do you have names and addresses of families we might be missing?
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________