|
| |
| Thank you for
filling out the registration form!
Please verify that the
information you submitted is correct.
| Name: |
name
|
Birthday: |
month/dayBirthday
|
| Spouse's
Name: |
Spouse_Name
|
Birthday: |
month/daySpouse_Birthday
|
| Address: |
Address
|
|
|
| City: |
City
|
Zip: |
Zip
|
| Home
Phone: |
Home_Phone
|
Work
Phone: |
Work_Phone
|
| E-mail: |
Email
|
Fax: |
Fax
|
| Previous
Cities & State: |
Previous
|
|
|
| Children's
Names: |
Child1_Name
|
Birthday: |
month/yearChild1_Birthday
|
| |
Child2_Name
|
|
month/yearChild2_Birthday
|
| |
Child3_Name
|
|
month/yearChild3_Birthday
|
| |
Child4_Name
|
|
month/yearChild4_Birthday
|
| |
Child5_Name
|
|
month/yearChild5_Birthday
|
|
|
Copyright © 2001 Jamestown Newcomers Social
Club
Last modified:
April 09, 2003
|
