P.O. Box 1751 – Morristown, TN 37816-1751

Membership Form

(COMPLETED Form must be returned with Membership Fee)

Membership fee is $15.00 per person per calendar year (January through December)

PLEASE PRINT CLEARLY OR TYPE q New Membership q Membership Renewal

Last Name	First Name		Middle Initial	Maiden Name
Street Address / P.O. Box No.
City			State	Zip Code
Home Phone No.		Work Phone
Cell Phone No.		E-mail address

Please check (P) all that apply: If not checked, name will not be listed in directory

My name may be listed in the Reunion Directory ................................................................................................................. q Yes q No

My home address may be listed in the Reunion Directory................................................................................................. q Yes q No

My home phone number may be listed in the Reunion Directory............................................................................................ q Yes q No

My e-mail address (if applicable) may be listed in the Reunion Directory.................................................................... q Yes q No

I wish to receive additional information on Reunion of the Ages and/or Morristown College................................................... q Yes q No

Signature: Date:

FOR NEW MEMBERSHIPS ONLY:

Schools attended: Please check (P) ALL that apply and provide attendance dates, if possible.

SCHOOL / INSTITUTION ATTENDED	DATES OF ATTENDANCE
q Morristown College
q Morristown College High School
q West High School
q Judson S. Hill Grammar School
q Miller W. Boyd Grammar School
q Lowland Grammar School
q Pineville Grammar School
q Russellville Grammar School
q Whitesburg Grammar School
q Nelson Merry High School

For use by Reunion of the Ages only:

Date Received: _______________ Amount Paid: $_____________ q-Check q-Cash q-Money Order

NOTE: