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Date:
Name
Maiden Name
Street Address
City
State
Zip Code
Phone
Email Address
CHS Class of
Parent
Supporter
Spouse's Name
Your Occupation or Profession
Areas of Interest (Please Check)
Membership Homecoming Financial
Publicity Fundraising Other
Class Reunions Newsletter
Special Events Class Directory  

Category - Yearly (Please Check)

Regular          ($15.00)

Anvil Club      ($120.00)

Purple Club    ($500.00)

Gold Club       ($1000.00)

Please complete application and mail with check to:

 Central High School Alumni & Supporters' Association
P. O. Box 781
Harrison, TN
37341