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Epsilon Eta Alumni Association 2007
Membership Form
Please print this page and complete the form and mail to Elmer Brown.
Click here to download a PDF of the membership form.
| Name: |
________________________________________________ |
| Address: |
________________________________________________ |
| City/State/Zip: |
________________________________________________ |
| Occupation: |
________________________________________________ |
| Employer: |
________________________________________________ |
| Wife's Name: |
____________________ No. of Children: ______________ |
| email: |
________________________________________________ |
| Home Tel.: |
______________________ |
Cell No.: |
_____________________ |
| Work Tel.: |
______________________ |
|
|
| ______ |
President's Club ($100) |
Year Initiated: |
__________ |
| ______ |
Regular Membership ($20) |
Year Graduated: |
__________ |
| ______ |
EPSF Scholarship (Open. Please include separate check for this fund.) |
Group to which I would like to belong (please circle one):
1946-51 |
1952-56 |
1957-61 |
1962-66 |
1967-71 |
1972-76 |
1977-81 |
1982-86 |
1987-91 |
1992-96 |
1997-01 |
2002-06 |
| Make checks payable to: |
EHAA c/o Arlo Ragan |
| |
521 Kitts Hill Ct. |
| |
Centerville, OH 45459 |
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