Memphis Central High School, Class of 1986 Check In Form

Instructions:
1) Enter your information in the form below. The fields with RED labels are required.
2) When finished, click the VALIDATE button to validate the format of your entries.
3) If there are validation errors, they will appear above the form in RED. Correct the problems and click the VALIDATE button again.
4) When there are no validation errors, the SUBMIT button will appear at the bottom of the form.
5) Click the SUBMIT button to send your information to the planning committee.

First Name
 Middle Name
 Last Name (Maiden Name)
Married Name
Address
 City
State Zip Code Home Phone Work Phone Ext Mobile Phone
Email
 Company
 Spouse's Name
Children
Notes/Comments
Information Sharing (Choose one):
Allow classmates to see my information on this website
Allow classmates access to my name and email only on this website.
Allow access to my name only on this website		 20th Year Reunion Plans (Choose one):
I definitely plan to attend.
I may be able to attend.
I will not be able to attend.
Enter a username and password. This will allow you to login and modify your information and register for the reunion online. Username
 Password

Re-Enter Password

Click here to exit without submitting your information