ACSAA Membership Application

Afton Central School Alumni Association
Membership Application & Donation Form

As a graduate or past member of the Afton Central School, I wish to stay informed of school happenings, and news about people who attended my school.

Therefore I wish to join the Alumni Association by donating _____ (Minimum $5) for ___ years. The membership year is July to July.

___ I am interested in representing my class as a Class Delegate.

If donating more than the minimum, how should we direct the remainder?
Scholarship fund $ _______ Expenses $_______ Other $_______

Donation or not, please submit the following for our records.

FIRST & LAST NAME: ________________________________________________

ORIGINAL LAST NAME (if applicable): ___________________________________

CLASS YEAR: ___________

SPOUSE'S NAME (if applicable): ________________________________________

STREET ADDRESS: __________________________________________________

CITY, STATE, ZIP: ___________________________________________________

PHONE #: __________________________________________________________

EMAIL ADDRESS: ____________________________________________________

Note: Any information you provide may be shared with alumni officers and class delegates. Also, your email address, city and state of residence are posted on the ACSAA website. If you wish to have your personal information kept off the website, please check this box.

Please keep my email address off the website

Please send this completed form and its graciously accepted funding to:

Keith Willes, ACSAA Treasurer
P.O. Box 57
Pine Valley, NY 14872-0057

SORRY, CREDIT CARDS NOT ACCEPTED.