First Name
Middle Name
Last Name in '85 
Married Name

Current Address 1
Address 2
City
State
Zip Code
 

Birthdate (mm-dd-yyyy)

Home Phone Number
Work Phone Number
Email

Mail a Reunion Invitation? (Yes/No) Yes No

I received an invitation,                                                         
I am just CONFIRMING my address.  (Yes/No) Yes No