BLAIR ATHLETIC BOOSTER CLUB

ALUMNI/SENIOR CITIZEN

MEMBERSHIP FORM

2010-2011

YEARLY MEMBERSHIP FEE IS $10.00

NAME:______________________________________________

ADDRESS:___________________________________________

PHONE NUMBER:____________________________________

E-MAIL ADDRESS:___________________________________

PAID BY CHECK_____(CK#_______)  CASH________

THIS IS A NON VOTING MEMBERSHIP

PRINT AND MAIL BACK TO:

BLAIR ATHLETIC BOOSTER CLUB

C/O CHRISTY GRAY

PO BOX 108

BLAIR, OK    73526