CLAY - WIDEN ALUMNI ASSOCIATION 

Please mail to CWAA, P.O. Box 34, Clay, WV  25043

Please check all that apply:                                                                      Check here if this is a renewal—q

oI would like to join the Clay-Widen Alumni Association.

oLifetime membership of $100 is enclosed                      oYearly membership of $10 is enclosed

oMy spouse and I would both like to join the Clay-Widen Alumni Association.

oDouble Lifetime membership of $150 is enclosed        oDouble Yearly membership of $15 is enclosed

Name         _________________________________________________________________________________

First                                   Middle             Last                                                          (Maiden)

Home Address        __________________________Town_____________________State______Zip__________

Please check all that applies to you:

oClay High School Diploma __________ Year                   oWiden High School Diploma _________ Year

o Or what class would you have been in had you finished with your class?______Year_______School

oFriend and Supporter of Clay County Schools         o Faculty Clay High   o Faculty Widen High

Phone   (Home)________________________Fax_______________Email______________________________

Your Occupation    __________________________________________________

If Double Membership:

Name of Spouse____________________________________________________________________________

First                                   Middle             Last                                (Maiden)

Occupation of Spouse              _____________________________________________

Please check all that applies to your spouse:

o Clay High School Diploma __________ Year         oWiden High School Diploma _________ Year

o Or what class would have been in had you finished with your class?  _____Year  _________School

o Friend and supporter of Clay County Schools        o Faculty Clay High             o Faculty Widen High

Ideas or comments:

__________________________________________________________________________________________

Would you like to be a Friend and Alumni Partner in Science also?_________(Send info.)

My news: _________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

If your address changes, who is someone that we could contact that will always know where to find you?

Name____________________Address___________________Town______________State____Zip__________