Alumni Registration Form

Already a Registered Alumnus?

ONLY "REGISTERED ALUMNUS" MAY SKIP THIS FORM!
(Check Alumni List to see what your Alumni Status is before passing over this form!)

Privacy Statement: This registration form is used for the sole purpose of keeping an updated database of our Cordova High Class of 1973 classmates. The data collected here will be used for our ability to locate you for future reunions.  Should something happen to you, a memorial can be made in your honor. This information will NOT be distributed in any way to any group for any other purpose and will be kept confidential by the Reunion Organizer. This information is NOT FOR PUBLIC VIEWING!!!! It would be beneficial to have the form entirely completed, however I understand some may not feel comfortable answering all questions. Please only fill out what you are comfortable with!

Reunion tickets are limited!!!!! This event will be on a first registered, first reserved basis! Completing & returning this Alumni Registration Form will advance you to Registered Alumnus status. You will then receive Priority Notification when tickets go on sale at our website!  As a Registered Alumnus, you will also receive you’re OWN Personal Bio/Photo Page on the Class of ’73 Website & much, much more!

Complete & submit your completed Alumni Registration Form PROMPTLY!


                    Personal Information
 

Last Name (Maiden)
Married Name
First Name
Middle Name
Birthdate	(mm/dd/yy)
Street Address
City
State	Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington (State) Washington,D.C. West Virginia Wisconsin Wyoming
Zip Code + 4
Country
Home Phone w/Area Code	123-456-7890
FAX w/Area Code	123-456-7890
Email Address
Other Email Address
Webpage

Business Information
Occupation
Business Name
Business Position/Title
Business Street Address
Business City
Business State	Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington (State) Washington,D.C. West Virginia Wisconsin Wyoming
Business Zip Code + 4
Business Phone w/Area Code	123-456-7890 + Ext
Business FAX w/Area Code	123-456-7890
Business Email Address
Business Website
Family Information
Present Marital Status	Please Select One Married Divorced Separated Widow/Widower Engaged Domestic Partner Never Married
Number of Times Married	Please Select 0 1 2 3 4 5 6 7 8
Present Spouse Name  (include Maiden Name)
Present Anniversary Date	(mm/dd/yy)
If Spouse is Cordova Alumnus	Enter Year Graduated
Was an Ex-Spouse an Alumnus	Select One YES NO
If so, Who? (Include Maiden Name)
What Year Graduated?
Do you know their whereabouts?     (Provide ANY info you can!)
Children	Boys Select One 0 1 2 3 4 5 6 7 8 9 10     Girls Select One 0 1 2 3 4 5 6 7 8 9 10
Children Names & Birthdays               (mm/dd/yy)	Sample: Edgar Allen Poe  8/10/80
Grandchildren	Boys Select One 0 1 2 3 4 5 6 7 8 9 10     Girls Select One 0 1 2 3 4 5 6 7 8 9 10
Grandchildren Names & Birthdays                (mm/dd/yy)	Sample: Edgar Allen Poe  8/10/80
Great Grandchildren	Boys Select One 0 1 2 3 4 5 6 7 8 9 10     Girls Select One 0 1 2 3 4 5 6 7 8 9 10
Great Grandchildren Names & Birthdays                (mm/dd/yy)	Sample: Edgar Allen Poe  8/10/80
Do you have any brothers/sisters that went to Cordova?	select one YES NO
Name (Include Maiden Name)	Select Year for each   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95   Select One 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95
In Case Of Information Person(s) that can be contacted on your behalf to obtain memorial information should you pass away.
Name:
Relationship:
Phone w/Area Code:	123-456-7890
Email Address:
Mailing Address:
City:
State:	Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington (State) Washington,D.C. West Virginia Wisconsin Wyoming
Zip Code
2nd Possible Contact Person
Name:
Relationship:
Phone w/Area Code:	123-456-7890
Email Address:
Mailing Address:
City:
State:	Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington (State) Washington,D.C. West Virginia Wisconsin Wyoming
Zip:
Reunion Information
Did you attend any of the reunions?
If YES, please enter your guests name & his/her relationship to you at that time (i.e., Spouse, Date, Fiance', Friend).
5 year Reunion              Select One YES NO	Name and Relationship
10 year Reunion            Select One YES NO	Name and Relationship
20 year Reunion           Select One YES NO	Name and Relationship
Do you plan on attending  the 30th Reunion?    Please Select One YES Not Sure NO
Do you plan on attending  the Friday Night Icebreaker at the Hacienda in Folsom?   Please Select One YES Not Sure NO
If so, how many guests will you be bringing?   Please Select 0 1 2 3 4 5 6 7 8 9 10
Do you plan on attending  the Sunday Picnic BBQ & Award Celebration?    Please Select One YES Not Sure NO
Please List Names of all Attending (specify whether adult or children & ages of children)
Names You want on your (and guests) Reunion Badges  (FIRST name (Maiden Name) LAST name)
If NOT attending the Reunion, please let us know why!
Upon submission of this form, you will be a Registered Alumnus!