Print this form and mail with payment.  Please make your check payable to: Carl Junction Alumni Association.

Complete the form and mail to:

Carl Junction Alumni Association

P. O. Box 586

Carl Junction, MO 64834-0003


Name: _____________________________________________

Address: _____________________________________________

City: ________________________State:___Zip Code______

Amount contributed to Scholarship Fund $_____________

Amount contributed to General Fund $_____________

Total amount enclosed $_____________

In memory of: ______________________________________

(Donations are tax deductible.)