Professional Documents
Culture Documents
2012MembershipForm
Name______________________________________________________________________________
Address_____________________________________________________________________________
City________________________________________State__________ZIP______________________
Telephone___________________________Email___________________________________________
Class__________________Major_________________________________Degree________________
Profession_________________________________________
Enclosedis$___________for_______annualchaptermembership(s)at$25*perperson.
*Annualduesare$10foralumniwhograduatedwithinthelast20years.
Alsoenclosedismy$__________taxdeductibledonationtotheAlumniScholarshipProgram.
(donationsinanyamountaregreatlyappreciated)
Totalenclosed:$__________
PleasemakeyourcheckouttoCCCAC.
Pleasesendthisformandyourannualduespaymentto:
CentralCoastCalAlumniChapter
c/oHalLarson
2325ParklandTerrace
SanLuisObispo,CA93401