Membership and Contribution
Form

Annual: Single ( ) $10.00 Joint ( ) $15.00

5-Year: Single ( ) $40.00 Joint ( ) $60.00

Endowment Fund: ( ) $ ________

Academic Scholarship Fund: ( ) $ ________

Athletic Scholarship Fund: ( ) $ ________

Any amount received above dues will be considered a contribution toward the endowment fund unless otherwise specified.

Name : _______________________________________

E-mail: __________________

Address:
_______________________________________________________________

_______________________________________________________________

Telephone number:
______________________________________________________

Class Yr: ___________________

Mail the form and your check to:

CFHS Alumni Association
P.O. Box 118
Clifton Forge, VA 24422

Thank you. We appreciate your support.