APPLICATION
 Membership/Renewal of Membership

Name     Year Graduated 
Address 
City     State     ZIP 
Amount Enclosed $ Home Phone 
Email    Work Phone 

DUES SCHEDULE
(Please check appropriate item)
Regular Members
$20.00 per fiscal year
$-0- first fiscal year after graduation

Associate and Honorary Members
$20.00 per fiscal year, Associate Member
$-0- Honorary Member

Lifetime Member
$20.00 for life (alumnus who graduated 50 or more years ago)

PAYMENT INFORMATION

If paying by credit card, fill out below.

Check Appropriate Box
 
MASTERCARD AMERICAN EXPRESS VISA
 
   
CARD NUMBER AMOUNT
SIGNATURE _____________________________ EXP. DATE

If paying by check, make check payable to:

St. Louis Alumni Association


Print form, attach check and mail to:

St. Louis Alumni Association
916 Coolidge Street
Honolulu, Hawaii 96826