WHS 2010 CLUB DUES

Alumni Information

Name:                                                                                                                                                  Class:

Date of birth:

Home Phone:

                                         Cell Phone

Current address:

City:

State:

                                           Zip Code

Spouse’s Name:

Email Address:

Date:

Backup email address:

Emergency Contact

Name of a relative not residing with you:

Address:

Phone:

City:

State:

ZIP Code:

Relationship:

Email address:

DUES:

Dues for 2010  $10.00  [] (Flashlight link and news emailed)

Dues for 2010  $15.00 [] (Flashlight sent via ‘Snail Mail')

WHS Alumnni Club

PO BOX 774

O'Fallon, MO 63366

Any questions? call: 636-696-4693