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Membership Form

Name: ___________________________________ Grad Yr: ____________ School Graduated From:______________________

(Women include maiden name)

Occupation: _____________________________________

Spouse: __________________________________ Grad Yr: _____________School Graduated From:______________________

Present Address: ________________________________________________________

City: ______________________________ State: ___________ Zip: _______________

E-Mail Address(es): ________________________________________________________

Please place my name on your e-mailing list. YES: ______

Become a "notifiable member" now by printing and completing this form and mailing to:

LaGrange-Keystone Alumni Association
 c/o Susan Crittenden Farschman
 511 Riley Court
 LaGrange, Ohio 44050


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