Member
Membership Status
*
New Member
Returning Member
Early Panther (Joined Apr 1st - June 30th)
(PERSONAL INFORMATION)
*Required for Periodic Alumni Updates
Name
*
Mr.
Mrs.
Ms.
Dr.
Rev.
Atty
PREFIX
FIRST NAME
MIDDLE NAME
LAST NAME
MAIDEN NAME
*
GRADUATION/CLASS YEAR
*
Please Select
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
HIGH SCHOOL NAME
(Please Enter School Name, IF NOT Lake City H.S)
MAILING ADDRESS
MAILING ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOME PHONE
*
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:
Payment Method (Payable to LCHS Alumni Association)
*
Debit/Credit Card $31.50
PayPal $32.00
Welcome Panthers and Pantherettes!!!
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