PSU Membership Application

Please fill out this form legibly and as completely as possible.
The Chapter wants to make sure we have the most accurate contact information for you. Please be sure that your most recent contact information is also current with the national PSU Alumni Association.
Thank you for your support!

*required fields

* Full Name: (First, M.I., Last)

* Class Year:

* Degree: (B.S., B.A., etc.)

* Major:

* Address:

* City:

* State:

* ZIP:

* Home Phone (ex. 919999999)

   Work Phone: (ex. 919999999)

   Cell Phone: (ex. 919999999)

   Employer:

* Should We Also Contact
Your Spouse?:

Yes
No

   Spouse's Class Year:

   Spouse's Name:

   Spouse's Degree:

   Spouse's Major:

   Spouse's Alma Mater:

   Spouse's Email:

   Spouse's Cell Phone: (ex. 919999999)

   Spouse's Work Phone: (ex. 919999999)

   Spouse's Employer:

* How Many School Age Children?:

* Are You National Members of
Penn State Alumni Association?

Yes
No

* May We Contact You Via Email?

Yes
No

* Are You Willing To STOP
Receiving Paper Newsletters And
START Receiving Newletters Via
Email?

Yes
No

   What Activities Would You Like
See Our Chapter Offer?

* How Will You Pay?
(instructions will follow after you
submit the form)

PayPal
Check/Money Order