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ALUMNI MEMBERSHIP APPLICATION FORM

Name: ___________________________________________CHS Class: ______Date:_________

Address: _________________________________________ Phone: ( ) __________________

______________________________________________ E-mail: _________________________

Occupation: _____________________________________________________________________

Tell us about yourself:_____________________________________________________________

_______________________________________________________________________________

Have you served in the Armed Forces? If yes, when and where: ____________________________

___Life membership $25. ___ Century Upgrade $75. ___Century membership $100.

Make check payable to CHS Alumni Association and mail to

P.O. Box 217, Wyncote PA 19095-0217