Membership Form

Annual:  (  )-Single-$10.00    (  )-Joint-$15.00

5-Year:   (  )-Single-$40.00    (  )-Joint-$60.00

Endowment Fund:  (  ) $__________________

Academic Scholarship Fund:  (  ) $________________

Athletic Scholarship Fund:  (  ) $________________

Any amount received above with dues will be considered a contribution toward the Endowment Fund.

Name: _____________________________________________

Email: _____________________________________________

Address: ___________________________________________

                ___________________________________________

Telephone number: ___________________________________

Class Year: ____________________________

Mail the form and your check to:
MHS Alumni Association
P.O. Box 67
Moberly, MO  65270

Thank you.  We appreciate your support.

We are a 501(C)(3) tax exempt organization.

September 2009
Cheryl Allen allen.c@att.net