BECK Alumni "Roll Call"

This "Roll Call" form requests Beck Alumni (Students & Staff of the former "Sir Adam Beck Collegiate" - London Ont. Canada) to identify current "Contact Information".

This information will be held in confidence, and will only be used for contacting you for "Beck related events" (Reunion, Singing Auditorium, etc.).

- As a minimum please input your name and primary point of contact (email preferred) .

- If submitting information about another person then show your name in the "Submitted By" field.

- "Tab" key steps through the fields in sequence.

First Name
Surname / Maiden Name
Married Name
Spouse's First Name
Spouse attend Beck? - last name at Beck
Student / Teacher/ Both
Years Attended
Grad Year
Street Address
City
Province/State
Postal Code
Country - replace if other than Canada
E-mail
Home Phone
How listed in Tel Directory (Name)
Interested in helping with activities?
Notes:
Submitted by

Thank you for joining our Alumni database. All Information will remain confidential and will not be circulated.

BECK Alumni "Roll Call"

Beck Reunion Committee. Revised: 09/07/06

Beck Reunion Committee.
Revised: 09/07/06