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Southern Nash High School

6446 Southern Nash High School Road

Bailey, NC 27807

School - 252-451-8520 Fax

– 252-478-5953

Alumni Association Membership Form

Title

(Mr, Ms, Dr)

First Name Last Name

Membership Year: January 2015 – July 31, 2016

Street Address

City

Email Address

State

Phone Number

Last Name during High School

(if different)

Zip Code

Graduation Year

Membership Levels

(Please check the corresponding box)

Beginning Birds

$10

Newsletter, Recognition, Alumni Decal

(For Alumni who have been out of school 4 years or less)

Staff

(Current, Former, Retired)

$25 Newsletter, Recognition, Alumni Decal

Firebird Member

$50 Newsletter, Recognition, Alumni Decal

Big Red Firebird

$250

Newsletter, Recognition, Alumni Decal, One (1) All-Access Pass to school events

Bronze Firebird

$500

Newsletter, Recognition, Alumni Decal, Recognition at Homecoming Football

Game, Two (2) All-Access Passes to school events

Gold Firebird

Platinum Firebird

$1000

$2500

Newsletter, Recognition, Alumni Decal, Recognition at Homecoming Football

Game, Recognition during Alumni Night during Basketball Season,

Four (4) All-Access Passes to school events

Newsletter, Recognition, Alumni Decal, Recognition at Homecoming Football

Game, Recognition during Alumni Night during Basketball Season,

Six (6) All-Access Passes to school events

Appropriation of Funds

Forty percent (40%) of your membership will be allocated to the Alumni Association Scholarship fund. If you wish for the remaining percentage to be appropriated to specific areas within the school, please indicate by writing the percentages next to those areas (not to exceed 60%).

Please make check payable to:

Southern Nash High School PTO/Alumni Association

Academics

40% Alumni Association Scholarship

Athletic Program

Band Program

Chorus Program

FFA Program

Media Center

PBIS (Positive Behavior Support)

PTO (Parent/Teacher Organization)

Other:

Please specify

Tax receipt will be mailed to donor address listed above.

Thank you for your membership to

Southern Nash High School Alumni Association. t n

) r e f e f i d f i

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