PURDUE CLUB OF SOUTHWEST FLORIDA
MEMBERSHIP FORM
WE ENCOURAGE ALL PURDUE PEOPLE AND FRIENDS IN SOUTHWEST FLORIDA
TO JOIN THE PURDUE CLUB OF SOUTHWEST FLORIDA

For the 2002 Calendar Year - Dues $15 - One Individual dues also covers spouse

Name (print)________________________________________________________________

Spouse____________________________________________________________________

Primary Address_____________________________________________________________

Alternate Address____________________________________________________________

Dates to use Alternate Address:   From_________________________to_________________

Business Address____________________________________________________________

Preferred Name(s) for Namebadge_______________________________________________

Preferred Name(s) for Namebadge (spouse)________________________________________

School & Class_________________________________Spouse_______________________

Phone__________________________Business Phone_______________________________

Email_____________________________________________________________________

Enclosed is a check payable to Purdue Club of Southwest Florida for 2000 dues $__________

I am including an additional amount ($10 or more) for the Honors Program         $__________

Make Checks Payable to:  Purdue Club of Southwest Florida

PRINT AND MAIL THIS FORM TO:
Purdue Club of Southwest Florida
PO Box 110153
Naples, FL 

Help Us Help Purdue By Being A Dues Paying Member and Participating In Our Activities