|
Membership # _______
The BHS Alumni Association, Inc.
Membership Application Form
(Cut, Copy & Paste As A WORD Document; Keep a Copy For Your Records)
_____________________
Today's Date
Please type or print legibly and mail to the address below:
(Please circle title Dr./Mr./Mrs./Ms.)
Name of Applicant (include maiden name):_______________________________________________________
Mailing Address:
___________________________________________________________________________
Street City State Zip
â–¡ Alumni Class of ______ â–¡ Non Alumni
Phone: Work: ( ) _______________________
Cell: ( ) _______________________
Home: ( ) _______________________
E-mail address: _________________________________________
Birth date: ________________________________
Occupation: ________________________________________________________________________________
Spouse: Dr./Mr./Mrs. ________________________________________________________________________
Did he or she attend BuchtelHigh School? ž Yes What year? _____ ž No
Number of Children/Age (Optional) ________/________
Please check the appropriate membership level:
â–¡ BuchtelHigh School Alumni Association Membership - $25.00
â–¡ Associate Membership - $25.00
â–¡ Lifetime Membership Scholarship Endowment - $250.00
The Buchtel High School Alumni Association has permission to list the above information in the Membership
Directory â–¡ Yes â–¡ No
The Buchtel High School Alumni Association has permission to post your e-mail address on the Alumni Association Web Site? â–¡ Yes â–¡ No
Make checks or money order payable to: Buchtel High School Alumni Association, Inc.
Send to: P.O. Box 22156 ATTN: Scholarship Endowment Fund/Membership
Akron, OH 44302-2153
Mission Statement
The Buchtel High School Alumni Association, Inc. is committed to the global success of BuchtelHigh School through academic programs, scholarships and athletics. We are strongly dedicated to the pride, success, and excellence of the Buchtel Cluster Community.
www.gogriffs.net
For internal use only:
â–¡ Cash â–¡ Check # _______ Money Order # _________________
â–¡ New â–¡ Renew
|
