------------------------------------------------------------------------------------------------
Parent Information
Name ------------------------------------------------
Address ------------------------------------------------
City, State Zip ------------------------------------------------
Phone Number ------------------------------------------------
Email (important) ------------------------------------------------
Congressional District ------------------------------------------------
Cadet/Graduate
Information
Grad Rank ------------------------------------------------
Name ------------------------------------------------
Company & Regiment or ------------------------------------------------
Grad Division/Battalion ------------------------------------------------
Address or Box Number ------------------------------------------------
City, State, Zip ------------------------------------------------
Birth Day ------------------------------------------------
Class year ------------------------------------------------
Email ------------------------------------------------
Membership Dues
($35 for
Cadet Parent) ------------------------------------------------
($20 for
Graduate Parent) ------------------------------------------------
Magnetic Name Badge ------------------- x ------------- = ----------
($6 each includes shipping)
Total Enclosed ------------------------------------------------
Name Tag 1 Name Tag 2
Parent 1 ----------------------------------- Parent 2 --------------------------------------
Cadet Name/Year ----------------------- Cadet Name/Year --------------------------
Check Due by September 1, 2010
Please make checks payable to West Point Parents Club
Call to return form and check to: Kevin and Mary Kohne
3153 Pine Brook