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: ____________________________________________

Other Information:

Home Phone Number: _____________________________________________

Cell Phone Number: _______________________________________________

Occupation: _____________________________________________________

Degree(s): ______________________________________________________

Year Graduated: ___________           OSUAA Member:       YES           NO

Membership Type:       New           Renewal

OSU Alumni (attended at least 1 quarter):       YES           NO

Interested in serving on the board:     YES           NO       Committee:      YES           NO

Comments: _______________________________________________________

________________________________________________________________

Make checks payable to:

The OSU Alumni Club of the Sacramento Valley

Mail to:

Stephanie Gaiser

9589 Four Winds Drive, Apt 1113

Elk Grove, CA 95758

Tel. (916) 838-2256

steffig1tridog@comcast.net