Charleston Chapter Membership Application
Name: __________________________________________________________
Address: ________________________________________________________
City: ________________________ State: _________ Zip Code: __________
PHONE: (
) _____- ___________
EMAIL ADDRESS: ________________________________________________
EMAIL ADDRESS 2: _______________________________________________
(Most announcements will go out over email, please include if you have one.)
What is your class/graduation year (if applicable)? _____________
Penn State College and Major: _________________________________________
Renewing Member of the Charleston Chapter? Yes ____ No ____
Are you a member of the PSU Alumni Association? Yes ___ No ____
If Family Membership, please list family members:
__________________________________________________________________
__________________________________________________________________
WE INVITED YOU TO GET INVOLVED!
Committee Interests (Please check below):
_____ Nominating
_____ Finance
_____ Membership
_____ Social
_____ Communications
_____ Community Service
_____ Golf Event
(over)
Please check Membership Level below:
______ Single Alumni Membership ($10 Annually; $50 Lifetime)
______ Family Alumni Membership ($15 Annually; $75 Lifetime)
______ Single Associate Membership* ($10 Annually; $50 Lifetime)
______ Family Associate Membership* ($15 Annually; $75 Lifetime)
* Note: An Associate Member is anyone who is not an alumnus of The
Pennsylvania State University
Please Make Checks Payable To:
Charleston Chapter of the Penn State Alumni Association
Send This Form With Payment To:
Chris Bauman
1393 Lettered Olive Lane
Mount Pleasant, SC 29464
Memberships valid for one year
WE ARE PENN STATE
CHARLESTON!!