Father's Name: _____________________________________________________________________________

Nationality:____________________________________ Occupation: _________________________________

Organization: _______________________________________ Title: __________________________________

Office Phone: ________________ Fax: __________________ E-mail: _______________________________

University: ________________________________________ Degree: _________________________________

Special interests, talents, hobbies: _____________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Would you be interested in: Being a guest speaker? _______

Assisting on field trips? _______ Sharing slides, pictures, artifacts? _______

Mother's Maiden Name: ______________________________________________________________________

Nationality:_____________________________________ Occupation: _________________________________

Organization: ________________________________________ Title: _________________________________

Office Phone: ____________________ Fax: __________________ E-mail: ___________________________

University: ____________________________________________ Degree: _____________________________

Special interests, talents, hobbies: _____________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Would you be interested in: Being a guest speaker? _______

Assisting on field trips? _______ Sharing slides, pictures, artifacts? _______

Country Day School