|
| Referred: |
|
| *First Name: |
|
| *Last Name: |
|
| Middle Initial: |
|
| Spouse First Name: |
|
Relation:
List All you can! |
(Niels Petersen, Niels Andrew Petersen, ..., YOU)
If you move, Please tell us!!
|
| *Address1: |
|
| Address2: |
|
| *City: |
|
| *State: |
|
| *Zip: |
|
| *Home Phone (provide at least one phone number): |
|
| *Cell Phone (provide at least one phone number): |
|
| *E-mail: |
(If you don't have e-mail, please type "NONE"! |
| Attending Reunion: |
|
| *Number Attending: |
'0' if not attending. |
| What may we display on our future Web Family Directory? |
Name
Email
Address
Phone
|
| Comment: |
|
|