Class
Gender
Title
First Name
Nick Name
Middle Name
Maiden Name
Last Name
Suffix Name
Female
Male
Female
Ms.
Mr.
Ms.
Mrs.
Coach
Reverend
Professor
Your Honor
Doctor
Deceased:
Date of Death (mm/dd/yy):
Street Address:
Address 2:
City:
State:
Zip:
Name on Monument:
Phone:
Cell:
Web Page:
E-Mail:
Please check the Sports and Activities in the boxes below
Band
Choir
Newspaper
Class Officer
Student Council
4H
NFA
Basketball
Baseball
Football
Track
Coach
Statistician
Trainer
Cheerleader
Contact Name:
Relationship:
Address:
Address 2:
City:
State:
Zip:
Phone:
Cell:
E-Mail:
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