Green Island High Alumni North American, Inc.
Application for Membership

The YELLOW input boxes are manditory.

All the others are optional.

First & Last name:

Address:

Apt:

City:

State:

Zip:

Year graduated: (yyyy)

Occupation:

Home Phone:

Cell/Work Phone:

E-Mail :

Upload Picture

I have read and understand the foregoing. The information submitted by me is true and correct. I also understand that any wilfull omission, falsification, misstatement, or misrepresentations above, will result in the rejection of my application.
Please pay your $20.00 membership dues online. Amount paid: $ registration/or dues link: Pay online
If deposited, the bank transaction number is: If I am accepted as a member, I agree to abide by the bylaws of the association.

Please make up a username and password that you will use to log into the system.
Username: Password:

Copy the security code below and paste it into the Code Check input box:
d911a803aa2e224996fd99baa7be6ffc

Code Check:

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