State Association Certificates will be presented for years of service in High Twelve beginning with 25 years and continuing in 5 year increments (i.e., 30, 35, 40, 45, 50 etc.) reaching their membership milestone in 2015. Please list members name and number of years.
You may submit the information on this form or on any form of your choosing and either email or send US Mail to Chairman Charles R. Coffey, 2nd V.P., 3185 E. Co. Rd. 360 N., Mattoon, IL 61938, Home 217-235-1388 Cell 217-273-7010, Email: firstname.lastname@example.org
Thank you for your participation.
MEMBERS NAME YEARS OF MEMBERSHIP