If you have internet access, it is easy to enter this information on line
at www.bcc57.org

Circle any information you do NOT want to appear on your web page

Name:________________________________________________
Nickname: _____________________ Homeroom:_____________
Email contact:__________________________________________
Home Address:_________________________________________
______________________________________________________
City:________________________________________State:_____ Zip:________
Home Phone:( ____)____________ Cell:(____)________________
Occupation:__________________________________ Retired: Y N Company:_______________________________________________
Work Add1:_____________________________________________
Work Add2:_____________________________________________
City:_____________________________ State:_____ Zip:________
Work Phone:(___)____________ Fax:(___)_________________
Work email:___________________________________________
Web site (work or personal):______________________________
Date of birth:_________________

See next page







BCC Class of 1957 Personal Information Questionnaire --- page 2

Married/Widowed/Single/Divorced/Other:____________________
Spouse or Significant Other Name:__________________________
Spouse or Significant Other Date of Birth:____________________
# of times Married:____________
#Children:_________ #Grand children:_________
#Great grand children:___________
College:________________________________________________
Post Graduate School:_____________________________________
Military - Years:______ Branch:___________ Rate/Rank:________
Interests or hobbies:_______________________________________
_______________________________________________________

Will you attend the reunion? Definite/Probable/No: D P N
Can you help on a committee? Y N

Include a recent photo of yourself as well as one of your significant other if available.

Send to:
Art Strasburger
5875 Oak Creek Lane
Greenwood Village CO 80121-1554

or Fax to: 303-738-0391