Madison High School
Parent Page Order Form
Return to Mr. Willoughby at the high school by  December 15, 2005.
 

 Name of student _______________________________________________________

 Name of Parent_________________________________________________________

City ____________    State ____     Zip _____    Phone ___________ 

Work Phone __________

A. 1/8 page - $45*    B. 1/4 page - $80   C. 1/2 page - $150   D. full page - $275

            _______ Check           _______ Cash            _______ Bill me