Membership Application and Donor Form:
Please print this form and return with your tax-deductible contribution made payable to:
Fairmont Senior High School Foundation, Inc.
One Loop Park    *    Fairmont, WV 26554

Name: ______________________________________
Address: _________________________________________________________
Phone Number: ______________________________
Graduation year: _______                email address: ____________ (optional)
Membership: Please check below only if you wish to become a member. The membership fees are:
Annual dues: [    ] $10
Patron: [    ] $50-249
Benefactor: [    ] $250-499
Lifetime Member: [    ] $500
Contributions: Please check the category below that applies contributions other than membership fees.
  [    ] Please indicate amount sent: $__________.   See below for designation...
Designation:   You can designate contributions to any of the funds/special projects listed below:

Scholarship funds:

 [    ] $500 Senior Scholarships (12-15 are awarded annually)
[    ] Tyndara Meffe Scholarship fund (awarded for creativity)
[    ] Anthony Pizatella Scholarship fund (awarded for social service career)
[    ] Dolores Maruka Scholarship fund

Auditorium fund drive:

[    ] Earmark for Auditorium Renovation project (2001-2002) see information below and be sure to complete the form at the bottom of the page if you are purchasing a chair

Other:

 [    ] Classroom Mini-grants requested by teachers for innovative projects
  [    ] Donation to be used for technology/equipment funding
  [    ] Unrestricted--use for furthering mission of Foundation
  [    ] I wish to be contacted about a gift of stock, property or other bequests for use of the       Foundation and Fairmont  Senior High School

The Fairmont Senior High School Foundation, Inc. appreciates the support of friends, alumni and parents of students.

PLEASE COMPLETE THIS ONLY IF YOU WISH TO DEDICATE AN AUDITORIUM CHAIR

Amount required for each chair dedication is $200.   You can make four monthly payments of $50.   Donors will be noted on chairs and can have this listed either "in memory of" or "in honor of NAME" or simply "Presented by (your name)". Please complete how you wish this to appear:

In memory of: ______________________________ Presented by: ____________________________
In honor of:   _______________________________ Signature:        ____________________________