The Ohio State Alumni Club
of Central Pennsylvania

MEMBERSHIP FORM

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Name		 ____________________________________
Spouse's Name
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Address
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City		 ____________________________________
Zip Code
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Home Phone		 ____________________________________
Work Phone
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Degree Year
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E-mail

 

Membership Dues - January 1st Through December 31st

 

Make checks payable to the:

Ohio State Alumni Club
           of Central PA
Mail to:
Joan Zurcher
1396 Lowther Road
Camp Hill, PA 17011

Please enroll me:
__________Single: $15
__________Joint: $25
__________Scholarship Donation (optional)
   
I am interested in serving:
__________Executive Committee
__________Planning Club Events
__________Student Outreach
__________Scholarship
__________Other