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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 2000 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
$__________ PRINT AND MAIL THIS FORM TO: Help Us Help Purdue By Being A Dues Paying Member and Participating In Our Activities
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