DMCS ALUMNI
Information Request Form

To keep you informed of alumni and DMCS events please fill out this form and mail or fax back to DMCS.

First Name:________________________ Last Name:_________________________

Maiden Name:______________________ Spouse Name:______________________

Address:__________________________

City:______________________________ State: ____ Zip:_____________________

Home Phone:_______________________ Work Phone: _______________________

Class Year:_________________________ E-mail Address:_____________________

Employer:__________________________ Job Title:__________________________

Supervisor's Name & Title_______________________________________________

Supervisor's Phone Number______________________________________________

You have my permission to contact my supervisor________ Yes  ________No

Spouse Employer:____________________ Spouse Job Title:____________________

If student, name of college/school:__________________________________________

Graduated from___________________________ Degree ______________________

Postgraduate Degree _______________________ Military Service _______________

Church:____________________________

Parents' Name:______________________ Address:___________________________

City:______________________________ State:____ Zip:______________________

Phone:____________________________ E-mail address:______________________

I would like to serve on the alumni committee ___Yes  ___No

I would like to be the class representative for the class of ___________.

Questions / Comments/ Ideas/ Tell us about yourself--married, baby, job promotion.

I hereby give DMCS permission to use my testimony in its publications or on its web site.

______Yes  ______No (Please attach your testimony if you so desire.  Thanks)