Princeton Association of Northern Ohio

MEMBERSHIP FORM

To register, please complete this form, or print and mail or fax to the address at the bottom.

Membership Category:
	$ - Life Time Membership (annual dues/all events for life)
	$ - Sponsor
	$ - Patron
	$ - Regular Member
	$ - Young Alum (Class has not yet celebrated 10th reunion)
	$ - Associate Member (Parent, Widow or Widower)
$	I would like to make a donation to Urban Studies Fellowship Program
	I would like to support Princeton Book Award(s) @ $ each
	Total Cost

Payment Information:
Credit Card:	American Express MasterCard VISA
Card Number:
Exp. Date:	(mm/yy)
Name On Card:
Personal Information:
	Required fields in red
Name:
Class:
Address:
City:
State:
Zip Code:
Phone:
Spouse:
E-Mail:

Work Information:
Company:
Title:
Address:
City:
State:
Zip Code:
Phone:
Your Input:
Please take this opportunity to give us your suggestions for activities, new programs and speakers that you would like to see incorporated into our schedule.

We are always looking for volunteers. Please indicate a specific area in which you might be interested in assisting:
	Alumni Schools/Interviews Special Events Annual Meeting Speaker Career Counseling Urban Studies Fellowship Young Alum Events Singing Groups Princeton Prize in Race Relations Other

If printing this registration form, please include your credit card information and fax to 216-696-2582, or include your check and mail to:

Princeton Association of Northern Ohio
1120 Chester Ave. Suite 470
Cleveland, Ohio 44114-3514