Membership Form for the annual period
of July 1, 2005 - June 30, 2006
PLEASE BLOCK PRINT
Thank you for your interest in supporting the Palisades High Alumni
Association and Dolphins After Dark.
Please print out this form and send it with your check. PLEASE fill in all
information. Thank you!
Graduation Year/Class of 19 _____ 200 _____
Full Name: (As it was in school) Last:
___________________________________________________________________
First: ____________________________________________ Maiden:
__________________________________________
If you have legally changed your name, please fill in your name above and
the change below:
___________________________________________________________________________________________________
Address:____________________________________________________________________________________________
Area Code/Phone Number:___________________________________ Fax:
___________________________________
YES ________ NO ________
You have my permission to list my name, graduation year on the upcoming
membership page on the website.
Please note your name may come up in on-line searches. The alumni
association has a strict policy to
never give out individual information on any alum.
YES ________ NO ________
You have my permission to list my name and e-mail address on the website.
(Please see above, additionally note that we can not control SPAM mail)
E-mail Address:
______________________________________________________________________________________
(This is important! Active members in the PHAA will have access to
our members only boards in June.
We must have your e-mail address to notify and include you).
My donation is in the amount of:
_____________
The below donations are accepted from one individual, a graduating class
or a company. If donation is
submitted by a particular class or company, we will only list the class
of... or the company name.
For donations of $25.00 or more, please see our Sponsor Page and e-mail us
for more information.
| Dolphins
Circle |
$1000.00
Plus |
Lifetime
Membership |
| Surf Circle |
$ 500.00 -
$ 999.00 |
Lifetime
Membership |
| Tideline
Circle |
$ 200.00 -
$ 499.00 |
Annual
Membership |
| Jetty
Circle |
$ 100.00 -
$ 199.00 |
Annual
Membership |
| Waves
Circle |
$
10.00 - $ 99.00 |
Annual
Membership |
Make your check payable to: Palisades Booster
Club, Alumni Fund
Mail to: Palisades High Alumni Association
15777 Bowdoin Street, Pacific Palisades, CA 90272
We are under the umbrella of the PBC but we have our
own treasurer and mailbox.
Your donation comes directly to us.
|