HAYTI CENTRAL SCHOOL-PARENT CHAPTER
2019 MEMBERSHIP FORM
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
(PLEASE PRINT)
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!