LSMSAAA Database

Information Update Form

If this is your first time to fill out the form, please do so completely. Otherwise, just fill in your name, grad year, and info that has changed.

Who (required)

Grad Year: 1986 (if you are not in the class of 1986, use the generic form)

First Name: Maiden Name: Last Name:

Nick Name: Middle Name:

Jump To: [contact] [chapter] [mailing lists] [family] [HS] [parents] [college] [professional] [news]

Contact Info

E-mail address:

Web page:

Address 1:

Address 2:

City: State: ZIP:

Country:

Phone Number: (home) (work)

(or keep filling out form)

Chapter Affiliation

(or keep filling out form)

Mailing Lists

Class List:

Region List:

Politics List:

For a description of these mailing lists, please see the Electronic Mailing Lists Page.

(or keep filling out form)

Family Info

Spouse Name:

Child Name:			<--Birth Year
Child Name:			<--Birth Year
Child Name:			<--Birth Year

N.B. if you have additional children, you can submit the form multiple times and we will correlate across forms

(or keep filling out form)

High School

High school attended before LSMSA:

(or keep filling out form)

Parents Info:

Names:

Address 1:

Address 2:

City: State: ZIP:

Country:

Phone Number: (home) (work)

(or keep filling out form)

College Info

College1:
Major:		Degree Awarded:		Year Awarded:
College2:
Major:		Degree Awarded:		Year Awarded:
College3:
Major:		Degree Awarded:		Year Awarded:

N.B. if you have additional colleges, you can submit the form multiple times and we will correlate across forms

(or keep filling out form)

Professional Information

Occupation:
Position:
Employer:

(or keep filling out form)

Additional information, news and updates:

(this is the end of the form; definitely submit now)

Database maintained by Steve Voss, LSMSAAA Secretary.