LCHSAA Membership Application 2023-2024

Member No.
Membership Status*

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

PrefixFirst NameMiddle NameLast 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

CityState

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??*

YesNo
OK TO RELEASE CONTACT INFORMATION TO LCHS ALUMNI COMMITTEE?*

YesNo
OK TO RELEASE EMAIL TO LAKE CITY HAPPENINGS FOR WEEKLY TOWN UPDATES?*

YesNo
Date*

MonthDayYear
Date
Signature*

Clear
Payment Method (Payable to LCHS Alumni Association)*

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

Welcome Panthers and Pantherettes!!!