Membership: June 1st - May 31st Dues: $5.00/year
	Date __________
	Hornell High School Alumni Assoc. Membership Application
	Name ___________________________(Maiden Name)____________________
	Street _________________________________________________________
	City/State ______________________________________ Zip ______________
	Class _________________
	Dues ___________________ (Please only include dues for 1 year)
	Scholarship Donation ______________________________
	Total ___________________________________
	Check here if new member __________________________

Please print the form below and send with your dues to:

Hornell Alumni Association, P.O. Box 135, Hornell, NY 14843

If you would like a membership card mailed to you please enclose a self-addressed stamped envelope.

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