Fairhaven Alumni Association

MEMBERSHIP ENROLLMENT, RENEWAL AND DONATION FORM

Please use this form if you are enrolling in the FAA for the first time, if your contact information has changed, or if you would like to make a donation. Print this form, fill out completely and mail with your payment to:

Fairhaven Alumni Association

PO Box 4382

Bellingham, WA 98227-4382

New__ Renewal __ Donation __

Member Name________________________________________________________________________________

First Middle Last Last Name in School

Spouse Name_________________________________________________________________________________

First Middle Last Last Name in School

Mailing Address_______________________________________________________________________________

Street Apt./P.O. Box

_____________________________________________________________________________________________

City State/Province Zip/Postal Code

Country ________________________ E-mail Address_______________________________________________

Telephone (Home)_______________________ (Office)_______________________ Fax____________________

$______	Fairhaven Alumni Association - Annual Membership Dues  - $10
$______	Donation in Memory of a Fairhaven Alumni ($20 minimum) Alumni Name: Approximate Dates Attended Fairhaven :
$______	Donation to the Scholarship Fund
$______	Contribution to Fairhaven Alumni Association
$______	Send me ___ copies of The Larrabee Book at $15 per copy
$______	TOTAL PAYMENT Please make checks payable to: Fairhaven Alumni Association

Thank you for your support!