New Profile Form

If you are a member of the Madison East High School Class of 1996 and are not already listed in this directory, please use this form to submit your current contact information, and, if you wish, your career and family info. These records will be the primary source of contacts come reunion time, so please keep all your information current.

Required fields are marked with an asterisk (*). If there is any information you wish to leave out of the online directory, please supply it anyway but click the checkbox under the heading "Private" and I won't post it. Thanks!


Contact Info


Last Name*:
First Name*:

Married Name:
Private

Street Address:




City:
State: Zip:

Phone

Main: () -
Alt: () -

E-mail*:
Web Site:

Occupation Info


Job Title:

Employer:

Employer's
Web Site:


Family Info

Children:
Birth Dates:
(not displayed on public profile)

Spouse's Name:

/ /

Married Since:

/ /





/ /





/ /