top of page

MEMBERSHIP APPLICATION FORM

Click the submit button below to send your completed form to the W. A. Pattillo High School National Alumni Association, Inc. 

**If you selected the Senior, Annual, or Sustained 5 Year category, you will prompted to submit your payment via PayPal on the confirmation page once you have submitted this form.** 

Click here to contact us with questions or concerns.  

Click here to download, complete, and mail a paper application form.

Name*

Address*

City/ST/Zip*

Checkbox List

Email Address*

Home Phone:*

Business Phone:

Cell Phone:

Year Graduated or Years Attended:*

I desire to work with the following committee or activity of the Association

Select a Category of Membership*

If you selected the Centenarian, Nonagenarian, Octogenarian or Senior category, please provide your year of birth.

Thank you for contacting us. We will get back to you as soon as possible

bottom of page