Please complete this form, enclose a check or money order for $25.00, payable to Hayti Central School-Parent Chapter and mail to:  Hayti Central School-Parent Chapter PO Box 506, Hayti, MO 63851



NAME: _______________________________________                  Class of: _____________________


ADDRESS: __________________________________________________________________________

Street                                                      City                                     State                              Zip Code


TELEPHONE: (Home) ___________________________        CELL: ______________________________


E-mail:  ____________________________________________________________________________


This year our membership drive is based on “Family & Friends”, to include husbands, wives, children, nieces, nephews, cousins and friends who are willing to help the Hayti Central School- Parent Chapter in this community mission.  Membership dues are as listed below:

*Lifetime membership, for individuals 65 and older:  $300.00 ____

Annual Membership Dues:  $25.00   ___Check ___Money Order     Total amount enclosed: $_______

(Annual dues cover the period from January through December 31.)


Are you an alumnus?  YES ____        NO ____


Signature: __________________________________


Freeda Ruff, President (816-820-4153)                      Bunny Johnson, Vice President (803-783-2781

freedaruff@yahoo.com                                              johnsonbunny47@yahoo.com


Membership Committee

Bunny Johnson, Co-Chair (803-783-2781)                  Vernice H. Jones, Co-Chair (816-942-0534)

Cleophas Harston (815-232-7214)                              Lorraine Jennings (731-394-4241)

Bernice Key (816-832-8458)                                       Ronnie Miller (816-737-9954)

Johnny T. Jurden (402-341-3735)


PLEASE NOTE:  We encourage all individuals who attended school in Hayti, Missouri – all families, friends, teachers and employees to join.  We would be honored to have you as a member!

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