PEABODY HIGH SCHOOL ALUMNI ASSOCIATION 

2010 ANNUAL MEETING REGISTRATION FORM

Saturday, June 12, 2010

For printable version click here
adobe acrobat needed

PHS Class of __________

Name: ____________________________________________________________
            First                                        M.I. or Maiden(VERY IMPORTANT)            Last

Address: ___________________________________________________________

               ___________________________________________________________

E-Mail:  _____________________________________ Date of Birth________________

PHSAA DUES          $10.00              ___________ 

SCHOLARSHIP CONTRIBUTION(S):

            General Fund                                                ___________

            Designated Fund(s) please specify below:
                        Dennison                                 __________
                        E.C. Barker                             __________
                        A.F. Bridges                           __________
                        Lucille Ayers                           __________
                        Walter Kilzer                           __________
                        Class of 1963                          __________
                        Andy Jonas                             __________
                        Clyde Page                              __________
                        Anne B. Love                         __________
                        Bill Jones Jr.                            __________
                        Andy Stott                              __________
                        Adam Hickerson                     __________
                        Dr. Larry Williams                  __________
                        Michael Harper                       __________
                        Judy Nunley                            __________
                        Aredus Buck Wade Jr.            __________
                        Matt Morris                             __________
                        Erika Kirk                               __________
                        Andy Yarbrough                     __________
                                   
            Scholarships Subtotal                                                                       ___________
           
            TOTAL ENCLOSED                                                                      ___________

Please print the registration form and

mail it along with your enclosed check to:

Peabody High School Alumni Association

PO Box 33, Trenton, TN  38382

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