Culver City High School Alumni Association

Membership Application
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Send this form and $15.00 to:
        CCHS Alumni Association
        P.O. Box 4343
        Culver City, Ca 90231-4343

Renewal __________          New Member__________ Year Graduated__________

Name First ___________________ Last __________________ Maiden ___________________

Address:
Number & Street _______________________________________________________________

City, State and Zip _____________________________________________________________

Phone___________________ Email ____________________________ Fax _______________

Optional Information:

Occupation____________________________________________________________________

Permission to release your address to other Alumni        Yes____ No ____

Permission to place your address on Website        Yes____ No ____
     Visit our site at: www.cchsa.org

Permission to release your email address to other Alumni        Yes____ No ____

Permission to place your email on the Website        Yes____ No ____

Would you like to help on Committees?        Yes____ No ____

Would you like to be notified about meetings?        Yes____ No ____

Any Interesting information you want to share? (married, children, adventures, etc.):