2008-2009 PSAA MICHIGAN CHAPTER MEMBERSHIP APPLICATION

 

Name:  ___________________________________ 

 

Street:  ___________________________________

 

City: ___________________ MI Zip:  ______________

 

E Mail:  ______________________________________

 

Phone: H- (____) _______________ W- (____) _______________Cell- (____) ____________

 

Major:  ____________________________Year(s) graduated:  _______

 

Profession:  _________________________

 

Employer or Business:  _________________________________________

I am interested in the following:

[__] TV Game watches

[__] Penn State athletic events in MI

[__] Recruiting at High Schools

[__] Organizing/helping with an event  

[__] Community service projects

[__] Happy Hours

[__] Golf outing

[__] Homecoming weekend

[__] Chapter dinners

Event Suggestions: ____________________________________

 

I want to join a committee: 

[__] Membership [__] Scholarship/Fundraising [__] Activities [ __] Communications

Enclosed please find my Annual Membership Dues of:  Single ($15)  ____or Couple ($20)  _____

2008-2009 Dues expire June 30, 2009.

I would like to receive the chapter newsletter by:  Regular U.S. Mail [__]   E-mail   [__]

 

I would like to receive other chapter communication by:  Email (__) Texting (__) Phone (__) H  W  C

 

Chapter Scholarship Programs:

[__] Enclosed is my tax-deductible contribution to the Local LSF Scholarship Fund  $ ________

[__] Enclosed is my tax-deductible contribution to the PSU Endowed Scholarship Fund  $  ______

(If enclosing a matching contribution form, please write a separate check for the contribution amount payable to Penn State University.)

 

Please send your dues and donation along with this form to the Chapter Treasurer Bob Veres, 16688 Dunswood Drive, Northville, MI 48168-2312.