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Alumni/ae Directory

We're developing an alumni/ae directory to continue to build and strengthen the Silver Lake community. Please complete this form so that we can add you to our online and print directories, and help you keep in touch with old friends!

Thank you!

First Name:
Last Name:
Maiden Name:
Nickname:
Address:
City:
State:
ZIP:
Home Phone:
Work Phone:
Mobile Phone:
Church:
Email:
Years of Participation	Please enter the four digit years you participated in the roles listed, separating each year by a comma, such as: 1999,2000,2001.
Conferee:
Camp Family:
Staff:
Counselor:
Dean:
Check this box to be included in the online directory:
Check this box to be included in the print directory:

The Connecticut Conference United Church of Christ
United Church Center
125 Sherman Street
Hartford, Connecticut 06105
(866) 367-2822
www.ctucc.org