Memory Book Submission

Note: Field Names in Red are Required.

Full Name (include Maiden name):*
Street Address:
City:
State:
Zip:
Preferred Phone Number:
Email address or Website:
Marital Status:
Spouse/Significant Other:
Children/Grand or Great-grandchildren:
Occupation(s) I have, or have had:
Favorite pastime activities:
My greatest pleasures in life:
My fondest Willamette memories or favorite professors:
Words of wisdom:
Additional comments: