Name(s): ________________________________________________________

Street Address: ___________________________________________________

City: ____________________________________________________________

State: ______________________________ ZIP: _________________________

Phone Number: ____________________________________________________

Email: ___________________________________________________________

Amount enclosed:

Dues are $25 per year for a single or family membership: __________________

Contribution to Scholarship Fund: ____________________________________

Total Amount Enclosed: ___________________________________________

Make checks payable to:

OSU Alumni Club of the Sacramento Valley

Mail to:

Jenn Still

409 Russell Park #2

Davis, CA 95616

Tel. (530) 756-1415

jstill_osu@sbcglobal.net