* Denotes required fields

Personal Information

First Name:*                        

Middle Name:

Last Name:*

E-mail address: *

Alumnus Current Occupation:


Camper Alumnus? Years at camp:     

Calendar Years at camp (eg. 1964-1968) 

Staff Alumnus? Years at camp:      

Calendar Years at camp (eg. 1964-1968) 

Spouse First Name:     Spouse Middle Name:    Spouse Last Name:
  

Spouse Occupation:

          

Home Address
Number and Street:*

City and State:*

Zip Code:*


Telephone
Home:          Work:          Fax:
  


Childrens Information
Child #1 Name:           

Child #1 Date of Birth:  

Child #2 Name:           

Child #2 Date of Birth:  

Child #3 Name:           

Child #3 Date of Birth:  

Would you like to receive information on camp for your children?
Yes   No
Would you like to receive information on staff positions 
for someone in your family?
Yes   No

Other Alumnus Information

Do you know of another camp alumnus who should be in our Alumni Directory?
Yes   No

If yes, please fill out the fields below:
Alumnus First Name:    Alumnus Middle Name:   Alumnus Last Name:
  

Alumnus Address Information
Number and Street:

City and State:

Zip Code:

          

Please share with us any news about yourself, your family and any special memories 
of camp you remember fondly: