Alumni Network Registration :::

Please complete the following form to register for the Alumni Network. The information requested will be added to the alumni database. Only your e-mail address will be accessible and only if you so designate. The rest of the information is for use by LTHS.  (NOTE:  *  = required field).

Name Information:
*Prefix: Select One Mr. Miss Mrs. Ms. Dr.	*First Name:	*Middle:
Maiden Name:	*Last Name:	Suffix: Select One MD Sr. Jr. II III IV V

Address Information:
*Address:		Home Phone:
*City:	*State: Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NC NE NV NH NJ NM NY OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WI WY	*Zip:

Other Information:
	*E-Mail Address:	*Year Graduated: Select One 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913
Yes, I agree to release my name and e-mail address and have it linked to the Find a Classmate section.

Business Information:
Company/Firm Name:		Title:
Business Address:
City:	State: Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NC NE NV NH NJ NM NY OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WI WY	Zip:
Business Phone:	Business E-Mail:

Yes, I am interested in joining the LTHS Alumni Association. (more info)

District 204 does not guarantee the authenticity of entries.