First name:
Former first name
Last name:
Former last name
Address:
Address line 2:
City:
State Zip:

Date of Birth January February March April May June July August September October November December 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 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Home Phone: Area Code: Number:
Work Phone: Area Code: Number:
Cell Phone: Area Code: Number:
Email address:

Current Occupation
Marital status Single Married
Childen (Name/Age)
Childen (Name/Age)
Childen (Name/Age)
Childen (Name/Age)
Childen (Name/Age)

Years involved in CYT (Check all that apply)
'80 '81 '82 '83 '84 '85 '86 '87 '88 '89
'90 '91 '92 '93 '94 '95 '96 '97 '98 '99
'00 '01 '02 '03

I am willing to be a member of the CYT Alumni Association planning Committee
I am interested in attending CYT alumni events.
Yes, am currently receiving mailings.
No, I have not been receiving mail. Please add my current information.