Purdue Club of Pittsburgh - Membership Form

	Purdue Club of Pittsburgh

The Purdue Club of Pittsburgh is a great place to meet others who take pride in Purdue. Membership is open to all alumni, students, and friends of the University. Our annual membership dues are as follows:
Single membership: $20 Household membership: $30 Current Students: FREE
Club dues can be paid by filling out the form and mailing it along with payment to: Purdue Club of Pittsburgh c/o Dave Moody, Treasurer 2124 Montour Street Moon, PA 15108

Name(s): _______________________________ Grad Yr: _________

_______________________________ Grad Yr: _________

Address: ________________________________________________

________________________________________________

Phone: ________________________________________________

Email: ________________________________________________

Membership Type: [Â Â Â ] Single ($20)
[Â Â Â ] Household ($30)
[ ] Student (Free)

Dues payment helps support club events, our website, and outreach efforts.

Name(s):	_______________________________	Grad Yr: _________

	_______________________________	Grad Yr: _________

Address:	________________________________________________

	________________________________________________

Phone:	________________________________________________

Email:	________________________________________________

Membership Type:	[Â Â Â ] Single ($20) [Â Â Â ] Household ($30) [ ] Student (Free)