HUGH PURVIS REUNION ASSOCIATION
MEMBERSHIP APPLICATION

	DATE - __________

       Yes!    I would like to join as a dues paying member of the Association. ?

       I am renewing my membership in the Hugh Purvis Association. ?
                                              
         Annual dues $20.00 ?
         Make me a lifetime member ...
		  			$100 (age 70 – 79)
	                         $50 (age 80 and older)
                                              
	Here is something extra to help pay the bills $ __________ 

                      
Please make checks payable to the Hugh Purvis Reunion Association and mail to:

			MICHAEL SPINELLI
			3396 RIPPLING LAKE CT.
			HAMILTON, OH  45011-8192

Please email me the Purvis Newsletter and save the postage for that snail mail ?

The Association intends to make available to the Active membership a directory which will 
include the information listed below.  We do not share this information outside of the 
association.

If you do not wish to be included in the directory please check the box ? 
and your information will not be included in the directory. 

I am not interested in any of this. Please remove my name from the mailing list  ?

First name__________________ Nickname ______________Last Name ______________________

Name of that significant other _________________________________________________________

Street address or PO Box  ___________________________________________________________ 

Town __________________________________________ State _______ Zip __________________ 

Email address _____________________________________________________________________ 

Phone (            ) _____________________________ Cell (             ) __________________________ 

Years on board 19 ________ to __________ Rate ____________ Rank_____________ 

The Hugh Purvis Reunion Association thanks you for being a member!

VISIT US ON THE WEB AT WWW.HUGHPURVIS.COM