Member Information Form-2018-19
Please complete the following form.
Last Name *
Your answer
First Name *
Your answer
Class of: *
Mailing Address
Please complete the following information to where you need information mailed.
House/ Appt Number
Your answer
Street
Your answer
City
Your answer
Zip Code
Your answer
Member's Cell Phone
Your answer
Home phone/ Parent phone/ Emergency Contact *
Your answer
Parent Name (s)
Your answer
Member's Murphysboro School Email (Required) *
Your answer
Member's alternative Email (optional)
Your answer
I understand that I am required to: *
Required
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