kaimuki automatically register

Class Roster 78

Please Fill Out Information Sheet Below

Your information sheet will be kept private, used only to contact you regarding upcoming meetings and events.

If you would like to have your e-mail or web site posted next to your name on the roster, please indicate yes or no.

First Name:
-- you can use mixed case

Middle Name:
-- you can use mixed case

Last Name:
-- you can use mixed case

Sr./Jr./I/II/III:
-- you can use mixed case

Maiden Name:
-- you can use mixed case

Nick Name:
-- you can use mixed case

Birthday M/D/Y:
-- 00/00/00

Address 1:
-- you can use mixed case

Apartment/Unit #:
-- you can use mixed case

City:
-- you can use mixed case

State/Zip:
-- you can use mixed case

Home Phone:
-- (area code) - (phone number)

Work Phone:
-- (area code) - (phone number)

Alternate Phone:
-- (area code) - (phone number)

Fax Phone:
-- (area code) - (phone number)

Pager Phone:
-- (area code) - (phone number)

Cellular Phone:
-- (area code) - (phone number)

Employment Name:
-- you can use mixed case

Position/Title:
-- you can use mixed case

E-mail Address: Yes or No
-- email you can use mixed case

Web Site Address: Yes or No
-- http://www.you can use mixed case

Spouse Name:
-- you can use mixed case

# Of Children:
-- you can use mixed case

Hobby/Interest:
-- you can use mixed case

Notes/Comments:
-- you can use mixed case