Information
Required for (Perpetual Memory Book/Directory) and
to
Receive Your User Name & Password
(Picture
& Bio are required)
(Use
Tab Key or Mouse, ENTER Can Prematurely Submit Form)
Complete Name in School (First-Middle-Last)
Your Present Name
Your Email
Repeat Your Email to
Verify
Your Mailing Address
City - State - Zip Code
Home Phone
Cell Phone
Birth Date (YYYY-MM-DD)
Who
will always know where you are? (Name, Phone & Email)
All
Entries Above Must Be Complete Before Form Will Submit
Do
you want your
email
included in the All School Directory? YesNo
Details for submission of "Biography & Pictures"
Biography should
include, at least, something about the following items, but can be as long
as you like.
(Name, place
& date of birth, family, places lived, early influences, education,
hobbies,
occupations,
significant incidents and major accomplishments).
Pictures should
include at least an old picture & current picture of you and/or family (kids, grandkids, pets
or whatever).
Submit your pictures
by separate email or regular mail (include info if you want pictures returned).
QUESTIONS
YOU CAN ANSWER INSTEAD OF WRITING A BIO!
Send
your Biography & Pictures to:
charley@kewpie.net
or
mail to:
CHARLEY
BLACKMORE
2312
DEER CREEK CT
COLUMBIA
MO 65201-3564
Questions:
573-442-1873
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Please
Send your Donation to "Charley
Blackmore's Class of '63 Scholarship"
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