Please mail to CWAA, P.O. Box 34, Clay, WV  25043

Please check all that apply:                                                                      Check here if this is a renewal_____

     I would like to join the Clay-Widen Alumni Association.

    __ Lifetime membership of $100 is enclosed                      __ Y early membership of $10 is enclosed

__ My spouse and I would both like to join the Clay-Widen Alumni Association.

__ Double Lifetime membership of $150 is enclosed        __ Double Yearly membership of $15 is enclosed

       Name:_______________________________________________________________________________

    First                                   Middle                           Last                                         (Maiden)

       Address: Street/POB ___________________________City ________________State _________Zip ______

Please check all that applies to you:

Clay High School Diploma __________Year      Widen High School Diploma _________Year

Or what class would you have been in had you finished with your class? ______Year _______School

__ Friend and Supporter of Clay County Schools      __  Faculty Clay High   __ Faculty Widen High

    Phone: Home ____________________Fax _______________Email ______________________________

    Occupation:  ___________________________________________________

If Double Membership:

                      Spouse:____________________________________________________________________________                           First                                     Middle                              Last                                                         (Maiden)  

     Occupation of Spouse:___________________________________________

Please check all that applies to your spouse:

 Clay High School Diploma __________ Year      Widen High School Diploma _________ Year

Or what class would have been in had you finished with your class?  _____Year  _________School

__  Friend and supporter of Clay County Schools      __ Faculty Clay High     __ Faculty Widen High

Ideas or comments:

            ___________________________________________________________________________________

Would you like to be a Friend and Alumni Partner in Science also? _________ (Send info.)

My news: _________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

If your address changes, who is someone that we could contact that will always know where to find you?

Name ____________________Address ___________________Town ______________State ______Zip ________

PLEASE PRINT AMD MAIL TO ADDRESS ABOVE