Maiden Name (if applicable):

Last Name:

Nickname(s):

During what years were you a Cicerone?

What offices, committee chairs or other positions (such as President's Hosts) did you participate in as a Cicerone? [please include year]

Did you win any awards, honors, etc. as a Cicerone?

Complete Mailing Address (please include street, city, state, zip, etc.):
(Needed for reunion mailing purposes.)

Phone Number (please include area code):
(Needed for reunion mailing purposes.)

May we put the following information on your profile page?
You may put my phone number and city/state Put my phone number only (no city/state) Put city/state where I live only (no phone number) Please don't put my phone number or my city/state

What's your birthday?
select a month January February March April May June July August September October November December select a day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Marital Status:
No Comment Single Dating Someone Committed Relationship Engaged Married Divorced Remarried

Children:
(Make multiple selections by holding down the Control key.)
None One on the way One Two Three Four Five or more

Tell us about your spouse and children, if applicable:

Do you have any pets? Tell us about them.

Tell us about your college & grad school (if applicable) education:
School(s), Area of Study, Degree(s), Year(s), etc.

Tell us about your occupation:
Company, job title, what you actually do, etc.

Anything else you'd like to tell us or remind us about?

E-mail Address:

E-mail Address:
(Please type your e-mail address again for verification purposes.)

Personal Web Site (if you have one):