Please print out this form and mail it to:
(IMPORTANT: PLEASE PRINT!)
NAME:__________________________________________________________
LAST NAME AT GRADUATION: ____________________________________
STREET ADDRESS:________________________________________________
CITY:___________________________ STATE: _____ ZIP: _________
TELEPHONE: (_____)_________________
GRADUATION CLASS: JANUARY 19_____, JUNE 19_____, JUNE 20_____
PLEASE CHECK ONE OR MORE:
ANNUAL DUES FOR
2007 -- $25
LIFETIME
MEMBERSHIP -- $100
SCHOLARSHIP -
GENERAL FUND -- $_________
IN MEMORY OF
_______________________ -- $_________
QUESTIONS ABOUT MEMBERSHIP STANDING?
WRITE, OR CALL ME AT 610-789-7673.
(FAX: 610-789-1095, E-MAIL: joelperlish@aol.com)