Robert C Byrd High School

The Roosevelt-Wilson/Washington Irving/ Kelly Miller & Robert C. Byrd Alumni & Friends Foundation,Inc.
One Eagle Way
Clarksburg, WV 26301

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1.) Foundation Membership Regular
Jan. 1 - Dec. 31

$15.00

Lifetime Membership

$200.00

2.) Special Contribution to the
Foundation (optional)
$500.00 A scholarship & Lifetime Membership

$______

Total Contributions to the Foundation (add lines 1 & 2)

$________

Tax deductible contributions should be made by check or money order and made payable to The Roosevelt-Wilson/Washington Irving Alumni & Friends Foundation, Inc. and mailed with this form to:
The Roosevelt-Wilson/Washington Irving Alumni & Friends Foundation, Inc.
One Eagle Way
Clarksburg, WV 26301

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MEMBERSHIP INFO:
Please return your membership fee to the
The R-W/WI/KM & RCB Alumni & Friends, Inc.
c/o Deborah Frum
One Eagle Way
Clarksburg, WV 26301 ______ New ______ Renewal
Name:____________________________________
School:_________________________
Membership Category _____ Lifetime _____ Regular
Graduate (Class of_____)
Contributor's Mailing Address____________________________________________

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