MSU VARSITY ALUMNI 'S' CLUB - MEMBERSHIP APPLICATION

Last name __________________________________________________________

Former name(s) ______________________________________________________

First name ______________________ Middle ______________________________

Address ____________________________________________________________

City _______________________ State __________________ Zip ______________

Telephone ________________________

Email _______________________________________________________________

Degree(s) __________________________ Year(s) __________________________

Sport(s) _____________________________________________________________

Year(s) played ______________________ Year(s) lettered ____________________

Occupation __________________________________________________________

Please include the information requested below, so that we may include it in a future newsletter:

Work and/or personal experiences since graduation that you would like to share:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Membership Level:

Recent Graduate/Expired Athletic Eligibility - First Year Gratis

(must complete membership application to receive first year free)

Annual Membership  $   40.00

Lifetime Membership  $ 400.00

Senior Lifetime Membership (Age 60 and older)    $ 200.00

I would like to make a donation  $ _________

TOTAL $ _________

Method of payment:

Check - Payable to MSU Varsity Alumni ‘S’ Club

Visa MasterCard

Credit Card # ____________________________________________________

Expiration Date __________________ Signature ________________________

Submit your Varsity Alumni 'S' Club Membership Form by one of the following ways:

• Print, complete with credit card info, and fax to MSU Varsity Alumni 'S' Club
  at (517) 355-7708.
  

• Save to a file, complete with credit card info, and email as an attachment to Staff@MSUVarsitySClub.org.
  

• Print, complete, and mail with check payment via regular mail to the following address::
  

MSU Varsity Alumni ‘S’ Club

276 Spartan Way

East Lansing, MI 48824

OFFICE (517) 355-8523

FAX (517) 355-7708