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1000 N Adams Dr
Decatur, Indiana 46733

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Bellmont High School Claim Form

Bellmont High School Claim Form for Brandon Wass

* Denotes required field
* First Name	Brandon
* Last Name	Wass	Enter your current last name.
Maiden Last Name		Enter only if you had a different last name while in high school. This will be used so other alumni can recognize you.
* Email Address		Alert: A confirmation link will be sent to this email address to complete signup.
* Retype Email Address
Receive Email Newsletter:	Yes No
* Password		Alert: Password is case sensitive, so please be sure to enter exactly as you want.
* Graduation Year	2011
* What are you doing now?
Share a note with other alumni about what you are doing now. You can always edit this later.
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