1. Last Name (1956):

2. Last Name (2001):

3. First Name:

4. Nickname:

5. Middle Name:

6. Date of Birth:

7. Current Address and Street Name:

8. City:

9. State:

10. Zip Code:

11: Home Telephone Number:

12. Home Fax Number:

13. Cell Phone Number:

14. Work Phone Number:

        Extension Number:

15. Work Fax Number:

16. Email

        Home Email Address:

        Work Email Address:

17. Employer:

Division of:

Work Address:

        Job Title or Profession:

18. Marital Status:

        (S = Single; M = Married; D = Divorced; W = Widow[er])

19. Graduated From:

High School:

        Junior High School:

        Elementary School:

20. Spouseís First Name:

        Nickname

        Middle Name:

        Date of Birth:

21. Name, address and telephone number of someone who would always know how to contact you:

22. Any additional information you wish to provide, including your family or work history, achievements, children, or any information about the residence or work address of classmate from John Muir and/or your Junior High School: (Feel free to send additional pages)

End of Questionnaire