Page Alumni and Friends Association
Membership Form
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Graduation Year
Choose Membership Level of Giving:
Please Select
BASIC $25-49
PIRATE CLUB $50-99
BRONZE $100-249
SILVER $250-499
GOLD $500-999
PLATINUM $1000-1,999
DIAMOND $2000-2,999
BLUE DIAMOND
$3000-4,999
PINK DIAMOND
$5,000
Choose how you would like your donation to be allocated:
As needed
Scholarships
Landscaping
Team Voyage
Page Cares/Pirate Pantry
Learn-To-Swim
My donation is in honor/memory of
Please fill in this blank if applicable.
My Donation
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USD
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