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Family Information Form
Use this form to notify the webmaster and/or reunion committee of a new family listing or for changes to personal information of a family. No information will be posted to the Family Directory without the express consent of the family and will only be used as you have specified below.

Family member name:

Your email address: (e.g.: you@aol.com)

Choose One

Spouse of family member

Children residing at home/year of birth

Address

City, state, zip

Phone

CHECK ALL THAT APPLY:
I do not want any of the above information posted in the family directory on our site
This information should only be used to contact me about reunion information
This information may be given out to family members, if requested.
I give permission to have all of the above information posted in the family directory on our site
I give permission except I do not want my email address listed
I give permission except I do not want my home address listed
I give permission except I do not want my phone number listed
I give permission except I do not want my children's names listed

Family Code # (for security)

You are a descendent of which son of Alexander and Helen Loychik? (click one)
Nick Loychik
Alex Loychik
John Loychik
Harry Loychik
Edward Loychik

Family member is son/daughter of