LCHSAA Membership Application 2021-2022

Member No.
Membership Status *

New Member Returning Member Early Panther (Joined Apr 1st - June 30th)
(Please Print Information)*Required for Periodic Alumni Updates
Name

Prefix First Name Middle Name Last Name
MAIDEN NAME *
GRADUATION/CLASS YEAR *
HIGH SCHOOL NAME
(Please Enter School Name, IF NOT Lake City H.S.)
Welcome Panthers and Pantherettes!!!
MAILING ADDRESS *

Street Address

Street Address Line 2

City State

Zip Code
HOME PHONE (If No Phone, Enter 000 000-0000) *
CELL PHONE *
PRIMARY EMAIL *
example@example.com
FACEBOOK PROFILE NAME
WOULD YOU BE INTERESTED IN HELPING ON OUR LCHS ALUMNI COMMITTEE?? *

Yes No
OK TO RELEASE CONTACT INFORMATION TO LCHS ALUMNI COMMITTEE? *

Yes No
OK TO RELEASE EMAIL TO LAKE CITY HAPPENINGS FOR WEEKLY TOWN UPDATES? *

Yes No
Date *

Month Day Year
Date
Signature *

Clear
Payment Method (Payable to LCHS Alumni Association) *

Debit/Credit Card $26.25 PayPal $27.00
Should be Empty:

Welcome Panthers and Pantherettes!!!