Name	(Maiden name in parenthesis or hyphenate)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Fax
E-mail
Work E-mail
Personal Web Page

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	Are you a Student or Faculty?  Student  Faculty
	Hastings or Elsik?   Hastings  Elsik
	Year graduated?  1984 1980 1981 1982 1983 1985 1986 1987 1988 1989
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