Name: Graduating Class:

Last Name at Graduation, if different:

Address:

City: State: Zip Code:

Phone Number: Fax Number:

E-mail Address:

Occupation:

Interested in becoming a mentor to DHS students? Yes No

If your spouse or children living at home are alumni of Douglas, you may register them also.

Spouse's Name: Graduating Class:

Child's Name: Graduating Class:

Child's Name: Graduating Class:

Membership Enrollment Fee is $10.00 per person, or $20.00 per family

Please make checks payable to: Douglas High School Alumni