Zanesville High School
Class of 1965
Questionnaire 

Please help us update our records before the reunion :

Title	such as: Dr, Mr, Mrs, Ms, etc
First Name
Middle Name
Maiden Name	if applicable
Last Name
Suffix	such as: Sr, Jr, II, III, etc
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
Home Email
Work Phone
Work Email

          Male Female          Occupation

Enter your date of birth :                                 Retired  Yes  No

-- mm/dd/yy  01/01/47

Junior High School

Military -yy/yy -Branch  -Rank

Single Married Divorced Separated Widow(er) Other

Please provide the following spouse information (if applicable):

Title
First Name
Middle Name
Maiden Name	if applicable
Last Name
Suffix
Cell Phone
Home E-mail
Work Phone
Work Email

          Year Spouse Graduated School

         Male Female        Occupation  

Enter the date of spouse birth :                              Retired  Yes  No

-- mm/dd/yy  01/01/47

Enter the date of wedding... :

-- mm/dd/yy  01/01/67

Would you like your email added to website ?

Yes No