Member No.
(Please Print Information)
*Required for Periodic Alumni Updates
Name
Mr.
Mrs.
Ms.
Dr.
Rev.
Atty
Prefix
First Name
Middle Name
Last Name
MAIDEN NAME
*
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
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
HOME PHONE (If No Phone, Enter 000 000-0000)
*
Format: (000) 000-0000.
CELL PHONE
*
Format: (000) 000-0000.
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
*
Payment Method (Payable to LCHS Alumni Association)
*
Debit/Credit Card $16.25
PayPal $17.00
Submit
Should be Empty: