MEMBERSHIP FORM (FROM THE INTERNET)      DATE _____________________

Print this form, fill it out, and mail with check to:
Mepham H.S. Alumni Association, 2401 Camp Ave., Bellmore, NY 11710

CLASS ____________   EMAIL ________________________________________________

FIRST NAME ________________ LAST NAME AT GRADUATION _______________________

LAST NAME TODAY, IF DIFFERENT ____________________________

STREET ADDRESS _____________________________________________ Apt __________

CITY _____________________________________ STATE______  ZIP _______________

COUNTRY (IF NOT USA)______________________________

TELEPHONE:    (_________)    _________  ___________________

MEMBERSHIP: __ NEW MEMBER     __ RENEWAL

ANNUAL DUES:   ___ INDIVIDUAL: $15     ____ FAMILY: $20

    ___ SUPPORTER: $25    ___ BENEFACTOR: $50     ___ PATRON: $100 OR MORE

W.C. Mepham H.S. Alumni Association is a 501(C)(3) non-profit corporation.
Your check will be your receipt.

Send us newsworthy items on your occupation, education, organizations, 
honors, wedding anniversaries, family, and activities that you would like 
to share in our publications. Comments may be edited for clarity and space
considerations. We like photos which may be used in our newsletters or 
magazine.  Photos will  not be returned.

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Please check the Missing Classmates lists on our web site,
http://www.mepham.org and tell us of anyone you can add to our mailing list.

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