Please provide the following contact information:

Name
Spouse (if applicable)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
Cell Phone
Work Phone
FAX
E-mail
Birthdate
Home Church

Alumni?

Yes No

Year Graduated:

What is your connection with NEWLHS? (List as many as apllicable)

Family info: (list any relatives who have attended NEWLHS & the year)

Employment Information:

Company

Company Address

Are you a member of the Annual Blazer Donor Program

Yes No

Would you like information on the Annual Blazer Donor Program?

Yes No

Is NEWLHS listed as part of your personal Planned Giving?

Yes No

Would you like information on the Planned Giving program?

Yes No