KESA Membership Form 2009-2010

KESA, P.O. Box 5, Kerens, Texas 75144-0005

Membership Levels:

Membership: $10.00 ( ) Yearly

LIFETIME MEMBERSHIPS:

( ) Bronze:250 ( ) Silver $500.00

( ) Gold: $750.00 ( ) Platinum: $1000.00

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Name (including Maiden)

Address Phone

City, State, Zip Code E-Mail

( ) Ex-Student CLASS of_____ ( ) Spouse ( ) Parent ( )Faculty ( ) Staff