LCHSAA Membership Application 2024-2025

Member
Membership Status*

New MemberReturning MemberEarly Panther (Joined Apr 1st - June 30th)
(PERSONAL 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)
MAILING ADDRESS
MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME PHONE*
*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:
Payment Method (Payable to LCHS Alumni Association)*

Debit/Credit Card $31.50PayPal $32.00
Welcome Panthers and Pantherettes!!!
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