Birthday Submission Form

THIS BIRTHDAY CLUB IS FOR ALUMNI AND STAFF OF
ROBERT E. PEARY HIGH SCHOOL ONLY

Join the Peary Birthday Club! Neal Pizzano (1976) came up with this idea to list your
birthday so that the rest of us will remember to send you a greeting and help you celebrate.
 So go ahead and sign up and we'll list your birthday!

Just fill-in the blanks. When you're completed with the entries, click on the "Submit"
button at the bottom. Thanks for your participation!

Use the TAB key or mouse to move between fields, not the ENTER key.
ENTER will submit the form prematurely!

Name: Maiden Name:

Primary E-Mail Address:


Alternate E-Mail Address:


Select Your Graduation Year


Are you currently on the Peary Alumni E-Mail Listings?
Yes No

If you graduated in 1985 or 86, please enter the school you
graduated from:

Your Birthday (month and day only, mm/dd):




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