P. O. Box 7774, Alexandria, LA 71306-0774
Website: www.geocities.com/peabody1967a Email: [email protected]
Membership Application
(Annual Membership period is March 1-Feb28)
(Please print clearly) Year Graduated
Name:
(First) (Middle) ( Maiden) (Last)
Address:
(Street) (City) (State) (Zip Code)
Telephone: ( ) ( ) ( )
(Home) (Work) (Cell)
Website: Email:
(Circle the type Membership)
* Graduate (Free) * Collegiate ($5.00) * Silver ($10.00)
* Regular ($20.00) * Associate ($25.00) * Affiliate ($30.00)
* Life/Regular (100.00) * Life/Associate ($100.00) * Life/Affiliate ($100.00)
* Life/Golden ($50.00) * Spouse $100.00 * Donation $___________
Signature: Date:
(Please make check payable to PHS Class of 1967 Alumni Association and Mail or Email Application.)