LWS Database Contact Information Update
We are confirming the database information for all contacts in our contact management system. Please complete this form so that we can ensure we have the best profile info associated with your LWS membership.
Full Name
*
First Name
Middle/Maiden Name (if applicable)
Last Name
In which program(s) were you a participant?
Winston
Salem
Connections
Flagship
INSIGHT
Class Year
Please Select
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Were you chosen or assigned the role of Class Connector?
Yes
No
Preferred Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Phone/Cell Number
*
Preferred E-mail Address
*
example@example.com
Are you retired?
*
Yes
No
Are you currently employed?
*
Yes
No
Current Employment Information
Company Name
Title
City
State
Zip Code
May we use your work email or cell number?
*
Yes
No
Work Email Address:
Work Phone:
Have you served as an LWS Board Member?
*
Yes
No
Years Served?
Have you served on an LWS Committee or Council?
*
Yes
No
Which committee(s) or council(s)?
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