Dues and Registration Form

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WPS Alumni Assn.
PO Box 72
Wishek, ND 58495-0072

WPS ALUMNI ASSOCIATION MEMBERSHIP DUES AND REGISTRATION FORM
SATURDAY, JUNE 16, 2012

I'm Enclosing:	Amount
Annual $8.00 (per household address) Membership Dues________.Donation.________	$__________
Golf Scramble Registration - $15.00 per person (includes green fee only)	$__________
Registration Fee, $20.00 per person (Deadline is June 2, 2012) (Refunds will be issued until June 2, 2012)	$__________
Limited Registrations at the door, $25,00 per person	$__________
Class List - $5.00 (per requested year) - Years(s) Requested________	$__________
Scholarship Fund Contribution.(These funds will be turned over to Dollars for Scholars.)	$__________
School Gym Floor Project (these funds will be turned over to Wishek Public School)	$__________
Total Enclosed	$__________

CLASS LISTS ARE AVAILABLE UPON REQUEST. PLEASE SEND $5.00 PER CLASS REQUEST

Alumni's Name:_______________________________

Maiden:______________________________________

Spouse's Name:________________________________

Address:______________________________________

City:_________________________________________

State:________________________________________

Phone#:_______________________________________

Class of:______________________________________

E-Mail Address:_______________________________

Would you prefer to get the Badger Bulletin by e-mail? Yes:_____No:______