Please Print this page, fill in the requested information and send it to our mailing address below. If you are including dues or donation, please check the appropriate boxes and fill in the dollar amounts included in your check. Thank you for your contribution.

Name: (First)________________________ (Last) _____________________________ (M.I.) ____

Address:_____________________________________________ City:______________________ State:_____________________   Zip Code:_________________  Apt # : ____________________

Home Phone:( ____ ) __________________    Work Phone:( ____ ) __________________    Cell Phone:( ____ ) __________________               Other:( ____ ) __________________

E-MAIL: _______________________________________________________   Please keep all my information off the web site.

Please fill in this section if you are making Paid Membership contributions. Check the box to indicate the contribution type. Fill in the dollar amount included in your check if you selected the Lifetime Commitment box. Make the check payable to the Glenwood School Alumni Association.  Enclosed is my contribution of: $25    Yearly Paid Membership. $500  Lifetime Paid Membership. $_____ Lifetime Commitment Paid Membership.       (Up to 5 payments of $100 or more in a 5-year period totaling $500)

If you wish to make an additional donation, check the appropriate box or boxes and fill in the dollar amount included in your check. Yes, I wish to donate $_______________ I am a family member or friend of a GSAA member. (Members full name:)__________________________ (Relation to member:) _______________ Reguarding this contribution, I wish to remain anonymous. I would like more information before contributing. Please send me more information.

Brief Comments or Questions:  ________________________________________________________________________________  ________________________________________________________________________________ GSAA Mailing Address Glenwood School Alumni Association 500 West 187th Street Glenwood, Illinois 60425 Telephone: 708-756-6108