Reunion registry (on-line)

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On-line Reunion Registry
* Required Information
Register now FREE on-line and receive a lifetime membership into our reunion registry (nominal donations are appreciated but not required. All donations are
used to help maintain the upkeep of the registry.)

All information entered will remain confidential and is never sold to third parties

Your Contact Information

*Last Name:
Maiden Name:
*First Name MI:
*Address:
*City: *State:
*Zip Code:
*County:
Home Telephone:
Work Telephone: FAX:
*E-Mail:
Sex: Male Female Date Of Birth://
City of Birth:
State/Province of Birth:
Country of birth:

My Ethnic background:
African-American Asian Hispanic
Caucasian Native American Other

If You are a part of an Adopted situation read the following:
If you were adopted fill out the next 4 questions with your information
If you are a parent looking for a child fill out the next 4 questions with the
child's information. Fill out as much as you know.

Name of Hospital:

Time of birth: Weight:

Date Adopted:// County:

Information about person your looking for:
(tell us what you know)

Last Name:
Maiden Name:
First: Middle:
Sex: Male Female
Date of Birth and/or Age:
City of Birth:
State/Province of Birth:
Country of Birth:

Ethnic background:
African-American Asian Hispanic
Caucasian Native American Other

Relationship to this person(friend,relative,etc.):
Spouse or other relatives name(s):

Any Other Information Or Comments that may be helpful:

Fill out as much information as you know leave the rest blank.

You have completed the necessary information. Please click the "Submit Order" button one time and you will be entered into the registry. If you wish to make a donation please follow the instructions below (optional).

Registry Donations Accepted
(Donations in any amount are used to maintain the reunion registry)

Please Note: Any person unlawfully using someone else's credit card (without
permission) for payment of services or to make a donation, can and will be prosecuted to the full extent of the law.

                           Check     Money Order

Card # Exp Date:
Amount $