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DREUX AMERICAN HIGH SCHOOL ALUMNI ASSOCIATION
DUES FORM  
(Please print legibly)

Full Name:  ________________________________________________
                  First                            Middle                                Last

Maiden Name: _____________________________________________  
Address:          _____________________________________________
                       _____________________________________________  
                       _____________________________________________
  (
Include Street/Route, Apt. #, PO Box, City, State/Province, Country, Zip)

Telephone:   Home      ______________________
      
              Work       ______________________
                     Cell          ______________________
                                    (Area Code + Number)  
Email Address:     
_________________________________________  
Alternate Email Address: ____________________________________
  (work, spouse)

Alumni/Faculty/Staff:
Class Year: ____________
If you didnít graduate from Dreux, Years Attended: _____ to_____ ie. 62-6
4
Faculty:  Years at Dreux       ________ to _______
Staff:       Years at Dreux      ________ to _______

Spouseís Name: ____________________________________________

Dues are $40.00 per year (based on a calendar year). You can also pay for multiple years, i.e. $80 for 2 yrs, $160 for 4yrs, etc.
 
$ ________________ [  ] 2017
$ ________________ [  ] 2018
$ ________________ [  ] 2019
$ ________________ [  ] 2020
$ ________________
[  ] 2021
$ ________________ Total Dues
$ ________________ Additional Donation/Contribution to support the Alumni Association activities, i.e. locating alumni, website, postage, etc.

$ ________________ TOTAL

Make Check payable to:  Dreux AHS Alumni Association
Mail this completed form and Dues payment to:
          
Jim Adams
           DAHS Alumni Assn
   
       188 Lexie Lane
        
 Palmyra, VA 22963

   
                     Thanks for your Support!!