I ___________________________ give my permission for Warren School to list the following information about me on their alumni website:
 

Name _______________________________________ (Maiden )__________________
 

Address _________________________________________________
_________________________________________________
_________________________________________________
 

Phone ________________
 

email address ________________________________________________
 

Year of graduation __________________
 

Additional information:
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 
 
 

Signature ________________________________ Date ________________
 

____ No, I would not like my information on the Internet. Please do not list me on the alumni pages.
 
 
 
 
 

*** Regardless of your response (yes or no) please mail back to the following address:

Warren School

1905 100th Street

Monmouth, IL 61462

Attn: Judy Eyler
 

*****If you know of other alumni who would like to be listed on the Warren School Alumni Pages, please pass the word along. Have them contact the school to receive a copy of this form.
 

Thank you!