Bio Update Form

Keep us up-to-date and let us know your current address, family additions, career moves, and anything else you would like to share by filling out this Bio Update Form or sending us email at bio_no_spam_please_@i_mean_it.no_spam_whatsoever.nyscaa.org!

If you have a photo you would like to include with your bio, please email it as an attachment to bio_no_spam_please_@i_mean_it.no_spam_whatsoever.nyscaa.org or include the link to your photo in the Comments section.

Camper Information
Title	(None) Mr Ms Miss Mrs Dr Reverend Father Brother Sister
Preferred Full Name	(e.g., Johnny Smith, Dr Rho D Dendron)
First Name
Middle Name
Last Name
Camp Last Name (or maiden name)
Suffix	(None) Jr Sr II III IV V
Nickname
Affiliation	[Select Affiliation] Delegate Staph Lecturer or Directed Study Faculty
Delegate State (or Country) and Year	(e.g., Hawaii 1982, Germany 2001)
Staph Participation
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Current Contact Information
Address Type	[Select Address Type] Home School Mailing Other
Length of Stay	Permanent Temporary until:
Address
City
State/Province
Zip/Postal Code
Country
Home Phone
Fax
Mobile Phone
Pager
Primary Email
Secondary Email
Web Site
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Backup Contact Information — Please fill this in! (The contact information of someone such as a parent, sibling, or friend who will always know how to locate you should any correspondence be returned. For administrative use only.)
Address Type	[Select Address Type] Parent(s) Sister Brother Daughter Son Grandparent(s) Other Relative Significant Other Ex-Spouse Friend Other
Contact Name(s)
Address
City
State/Province
Zip/Postal Code
Country
Home Phone
Work Phone
Email
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Employment Information
Title
Company
Address
City
State/Province
Zip/Postal Code
Country
Phone
Fax
Email
Web Site
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Bio Notes
Education -- Current and Any Degrees Received (e.g., BS Chemistry, Boston University, expected May 2005)
Current Occupation and Responsibilities
Family News (e.g., Weddings, Births, Adoptions)
Anything else you'd like to share!
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Privacy Preferences
Can we publish your Bio Notes information in the NYSCAA Alumni Newsletter (both postal and electronic versions)? Yes No
Can we publish your current contact information on the NYSCAA Web site? This will enable fellow NYSC alumni and staph to find each other. Yes, no restrictions Yes, with password protection enabled No
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Feel free to send us your ideas, thoughts, and comments!