Dues Form

DREUX AMERICAN HIGH SCHOOL ALUMNI ASSOCIATION
DUES FORM

Full Name: ________________________________________________
First Middle Last

Maiden Name: _____________________________________________
Address:          _____________________________________________
                       _____________________________________________
                       _____________________________________________
((Include Street/Route, Apt. #, PO Box, City, State/Province, Country, Zip)

Telephone:   Home      ______________________
                    Work       ______________________
                    Cell          ______________________
                                    (Area Code + Number)
Email Address:     _________________________________________
Alternate Email Address: ____________________________________
(work, spouse)

Alumni/Faculty/Staff:
Class Year: ____________
If you didn’t graduate from Dreux, Years Attended: _____ to_____ ie. 62-65
Faculty: Years at Dreux ________ to _______
Staff: Years at Dreux ________ to _______

Spouse’s Name: ____________________________________________

Dues are $40.00 per year. (You can also pay for multiple years, i.e. $80 for 2 yrs, $160 for 4yrs).

$ ________________ [ ] 2010
   ________________ [ ] 2011
   ________________ [ ] 2012
   ________________ [ ] 2013
$ ________________ Total Dues
$ ________________ Additional Donation/Contribution to support the Alumni Association activities, i.e. locating alumni, website, postage, etc.

$ ________________ TOTAL
Make Check payable to: Dreux AHS Alumni Association
Mail this completed form and Dues payment to:
           Marilyn Hutto Turner '62
           9831 Marine View Drive
         Mukilteo, WA 98275

                         Thanks for your Support!!