OAKMONT ALUMNI ASSOCIATION
	Oakmont Regional High School
	9 Oakmont Drive
	Ashburnham, MA 01430
	(978)827-5907

REGISTRATION FORM

First Name    _______________________  Last Name __________________________          

Maiden Name ______________________  Year of Graduation __________________

Street Address __________________________________________________________

City _________________________________ State __________  Zip Code _________           

Phone ____________   Email Address ______________________________________

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| Annual Dues $5.00 |		Administrative Use Only Date of Registration ___________________ Accepted by ________________________ Dues Paid  __________________________
_____________________________________________________ Classmates we should contact:
Name _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________		Contact Information _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________