Alumni Alumni Membership form Graduation YearName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Initial Last Suffix Birthdate* Date Format: MM slash DD slash YYYY Spouse's Name Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Initial Last Suffix Spouse's Birthdate Date Format: MM slash DD slash YYYY Anniversary Date Date Format: MM slash DD slash YYYY Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* ChurchCurrent Position at Your ChurchEmployerHometownCollegeMilitaryHobbies / InterestsWould you be interested in serving on a committee? Yes No If yes, please check the committee(s) that would interest you? Awards & Scholarships By-laws Fundraising Membership Events Would you be interested in serving as an Alumni Coordinator for your district or region? Yes No Would you be interested in volunteering? Yes No If yes, please check the volunteer area(s) that interest you? Recruitment for Payne Events at Payne Payne Fundraising Campaigns What alumni activities would interest you? Events Chapters Group travel programs Workshops Retreats Sporting Events Golf Outing Music & Theater Events Fundraising Other activities:Comments, suggestions, ideas:Share updates about yourself, family, career, church, and ministries.Membership* Price: $100.00 Quantity: Please mail in your dues made payable to PAYNE ALUMNI ASSOCIATION, 1250 S. Hawkins Ave., Akron, Ohio, 44320Upload a head shot photo for your Alumni Passport(Upload a high resolution jpeg photo)Share a photo(Upload a high resolution jpeg photo)Captcha This iframe contains the logic required to handle Ajax powered Gravity Forms. Alumni ASSOCIATIONrEV. BRUCE BUTCHER President, Alumni Association brucebutcher@earthlink.net 330-524-2907
