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Home Phone:     

Home Email address:   
 

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ALTERNATE ADDRESS:  Effective Dates (i.e.: Dec. 15 - March 15):

Alternate Mailing Address:          

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EMPLOYMENT:  Check here if retired:  Retired 

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Preferred E-mail (for committee correspondence):

CHILDREN:

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CC grad year:                       

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GRANDCHILDREN:

Name:             Birthdate:             HS grad year:         

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Name:             Birthdate:             HS grad year:                               

CC grad year:                       

Name:             Birthdate:              HS grad year:         

CC grad year:                       

Name:             Birthdate:             HS grad year:         

CC grad year:                       

WHILE AT CONCORDIA:

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Activities while at Concordia:  

REMEMBER WHEN:

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