Norris High School Alumni Association
Membership Enrollment/Renewal Form

Date: _________________    New Membership_______          Renewal __________

Last Name _____________________________First Name _______________________________

M.I. ________    Maiden Name _____________________________  Graduation Year _________

Address _______________________________________________________________________

City_____________________________________________      State ______      Zip __________

Phone Number _______________________     E-Mail Address ___________________________

Membership Type: (Please select one)

________    Active - Norris High School graduate

________    Associate - Graduate of Cortland, Firth, Hickman, Panama or Roca

Membership Fee: (membership terms are from June 1st through May 31st)

1-year $15.00                                             $_____________

3-year $40.00                                             $_____________

Lifetime Charter $300.00                              $_____________

Alumni Scholarship Fund Donation (optional) $_____________

Total Enclosed:                                           $_____________

Make check payable to:
Norris High School Alumni Association P.O. Box 63 Hickman, NE 68372