___ 1 Year $25.00       ___ 2 Years $45      ___ 3 years $60.00     ___Lifetime $500

 Name (include Maiden name if applicable)______________________________________

 Address__________________________________________________________________

 City_____________________________________________________________________

 State_________________________________________________   Zip_______________

 Phone____________________________________________________________________

 Email address______________________________________________________________

 SRHS Class of______________   *OR*   Friend of SRHS (mark here) ________________

 
 Membership contribution                               $__________________________________

 Additional contribution to further
 help the Foundation reach its
 goals of supporting SRHS                          $__________________________________

 Total contribution                                         $__________________________________


 Billing Information
  
 Please make check payable to "SRHS Foundation" and send it to:

 Santa Rosa High School Foundation,
 P.O. Box 11002
 Santa Rosa, CA 95406.