Please complete this form to submit your information as you would like to have it appear in the CH-EH Directory. You may submit information for the internal use of the Board only and specify that it not be published - just change the "Y" to an "N" in the corresponding squares. For the other fields, please just leave blank if you don't wish to have the information published. This information will be used only for internal, neighborhood association purposes like the directory and will not be sold or released to any outside entity. Don't forget to double-check your spelling.
Thanks! - Your Directory Committee.
Street # Street
For the above address, the following information should: modify the database; don't make any changes other than what's noted below. replace what was in the database; delete all prior information. Home Phone: Publish? Yes No Kid’s/2nd Phone: Publish? Yes No
Home Phone:
Resident #1: Publish Name? Yes No
Last Name: Suffix: First Name: Initial: Nick Name: Cell Phone: Publish? Yes No E-mail: Publish? Yes No Title: Organization: Work Phone: Ext.: Publish? Yes No Work Fax:
Resident #2: Publish Name? Yes No
First Name: Initial: Last Name (if different): Suffix: Nick Name: Cell Phone: Publish? Yes No E-mail: Publish? Yes No Title: Organization: Work Phone: Ext.: Publish? Yes No Work Fax:
Other Residents:
Children’s Names:
Questions? Comments? Corrections?