East Side High School
in Newark, NJ

Registration Form

This form is for adding New Entries only!

If you would like to make a change to an entry that already exists in the database, please use the Change Form.

If you are adding someone else to the American School of Lima Page,
please enter the following info:
Your Name
Your E-mail Address

A Password is required for all future updates, please remember it!
Password:

Necessary (Minimal) Registration Info:
This information will appear on the web site.

Class of: (ie. 1952 - Enter 'Faculty' if that's the case)
First Name:
Middle Initial:
Last Name:
Maiden Name:
(please, leave Maiden Name blank if not applicable)
Nickname:
E-mail Address:
(type "none" if that's the case)
Homepage URL:
(please, leave URL blank if not applicable)

The following fields are optional.
We would like the information for the Alumni Association Database.
If you would prefer that it not be published on the Internet select NO under Publish Data.
No data will be released to third parties (mailings lists, etc.)!

Publish Optional Fields on the Internet: Yes No

Personal:
Birthdate: (MM/DD/YYYY)
Spouse Name:
Children Names:
For the following numbers please remember the area or country code.
Home phone number:
Work phone number:
Mobile phone number:
Fax phone number:
Pager phone number:
Address
City: State:
Region:
Postal Code:
Country:

Education:
School/College:
Emphasis/Major:
Degree:
Graduation date [e.g., 6/95]:
(enter expected date if currently a student)

Employment:
Company:
Job Title:

Comments:
Hobbies:

Plans or personal notes:

Comments about the Alumni Home Page or this form:
Good job, Ray! Keep up the good work! :^)

Send questions and comments
to Ray Fernandez ('72) at: ray@eshalumni.org

East Side High School in Newark, NJ

East Side High School
in Newark, NJ