Memory Book Information Form

Copy and paste the form into an email, fill it out, and send it to jayson@jaysononline.com. The deadline is 11:55 PM Pacific Time September 21, 2008.

NAME AT THE TIME OF ATTENDANCE AT PRAIRIE:
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CURRENT NAME (if different):
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ADDRESS:
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CITY, STATE/PROVINCE, ZIP/POSTAL CODE, COUNTRY (if outside USA):
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TELEPHONE NUMBER (including area code):
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EMAIL ADDRESS:
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URL/WEB SITE (if any):
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SPOUSE (if applicable) - If PHS grad, please specify year:
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CHILDREN & GRANDCHILDREN (if any) - ages as of 8-01-2008:
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DEGREES EARNED SINCE HIGH SCHOOL (Please specify degree type, major and college or university):
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WHAT HAVE YOU BEEN DOING SINCE HIGH SCHOOL? (Please refer yourself in the third person as the information will be presented in the third person format. The information may be edited due to grammar and space limitations but will attempt to get as much printed as possible.)
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