Title: __ Mr. __ Mrs. __ Miss __ Ms. __ Dr. __ Rev. __ Sr.
First Name: _______________________________________ Middle Init.:______
Maiden Name: _____________________________________
Last
Name:_______________________________________ Class Year:________
Street Address:__________________________________________________________
City:_________________________________ State:_________ Zip:____________
Home
Phone:_____________________ Email Address:_________________________________
| Dues paid for: |
__ 1 Year ($5)
|
__ 2 Years
($10)
|
__ 3 Years ($15)
|
__ 4 Years ($20)
|
|
|
__ 5 Years ($25)
|
__ Other:
|
___ Years @ $5/Year
|
|
Spouse’s Name:(If Camden Alumni, include Class Year, if female Alumni, include include maiden name)
_____________________________________________________________________
Your
birthdate: _____- ____ -__________
Month Day Year
Temporary Address:
(If you have a temporary address, either for the Winter or Summer,
please indicate it below.)
Temp Street address: _______________________________________________
Temp City:__________________________ Temp
State:______ Temp Zip:_____________
Temp Phone Number:________________________________________
Your
parent’s name(s), if Camden Alums (include graduation year, also):
Name:___________________________________________________ Year: _________
Name:___________________________________________________ Year:_________
Current annual dues are $5.00 per year per person. Payment can be made for multiple years. Send your dues payment
to:
Camden Alumni Association
Daisy R. Brady, Registrar
35 Fourth Street
Camden, NY 13316
If paying by check, make payable
to Camden Alumni Association.