West Point Parents’ Club of Illinois

Membership Enrollment – Academic Year 2008/09

Please print clearly

Father’s Name___________________________________________________________

Mother’s Name__________________________________________________________

Street Address________________________________ ___________________________

City______________________________ State ______ Zip_______________________

Phone ________________________________ E-Mail ___________________________

Cadet’s Name_______________________________ USMA class of _______________

USMA company_____________________________ Cadet P.O Box________________

(Note: The WPPCI newsletter will be delivered to the above E-mail address)

For Plebe Parents - Each badge includes the parent’s name and their cadet’s first name.

Father’s name for badge (if different than above)_______________________________________

Mother’s name for badge (if different than above)______________________________________

Cadet’s first name for parents’ badges (if different than above) ___________________________

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Annual dues are $35.00 per household and $15.00 for alumni families.

* The initial name badges are free for Plebe parents and $8.00 apiece for upper-class parents to re-order. Please make check payable (for dues and badges if needed) to West Point Parents’ Club of Illinois. Mail this completed form along with check to:

Rich Niedbala Any questions, phone or E-mail:

2301 Brookway Drive Phone: (630) 845-0310 Geneva, IL 60134 E-mail: NIEDBALA6@aol.com

For WPPCI use only:

Check No. ___________ Amount Received _______________ Date ____________________

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Receipt – Initials ______________

Check No. ___________ Amount Received _______________ Date ____________________