NAME: ___________________________________________________________________
Last First M.I Maiden
ADDRESS:_________________________________________________________________
PHONE:___________________________________________________________________
Area Code Number
EMAIL:__________________________________________________________________
OCCUPATION:____________________________________________________________
One Year Membership: $20.00 Lifetime Membership: $200.00
Make Check to: Jeffersontown Alumni Association
Mail to: Myra Fugate
Alumni Association
Jeffersontown High School
9600 Old Six Mile Lane
Louisville, KY 40299