Thanks for checking into the Messick Class of 1969 website!

After you submit the form, a "thank you" page should be displayed.
If you would like to submit pictures for your CyberAnnual page (highly encouraged!), and attach the picture(s) to the email.
Please fill in all fields marked with a *
	Full name in 1969	*
	Current Name if different
	Street Address or PO Box	*
	City	*
	State	*
	Zip Code	*
	Telephone
	Email address	*
	Website URL
	Spouses name if married
	Info regarding children and grandchildren
	Your occupation
	Tell us about your life since 1969
	Any message you would like to share with classmates
	Your birthday
	Would you like your birthday remembered on the website	Yes No *
	Would you like a free Messick 1969 personal email address	Yes No *
	If so provide username and password for email account
	Would you like to receive occasional emails regarding major life events of classmates	Yes No *
	Would you like to receive a monthly email update of the Messick 1969 website	Yes No *
	May we post an encrypted link to your email so classmates can contact you	Yes No *
	Any special comments or instructions