Membership Application
06/20/2013
All fields marked with
*
are required fields.
Membership Type (choose one):
*
Annual:
See options below
Individual - $50
Joint: $60
2 year Individual: $85
2 year Joint: $110
3 year Individual: $120
3 year Joint: $185
Life:
See options below
Individual – $600
Joint – (2 people - same address) $750
Personal Information:
Title:
Mr.
Mrs.
Ms.
Other:
First name:
*
Middle name:
*
Maiden Name:
Last name:
*
E-mail address:
*
Penn State ID#:
*
PSAA ID number (Penn Stater label):
Street 1:
*
Street 2:
City:
*
State/province:
*
Country:
Zip code:
*
Is this a new address?
Yes
No
Home phone:
*
Business phone:
Are you an alum?
*
Yes
No
If alum, graduation year:
You can also join by phone by calling 1-800-548-LION and pressing "1" when you reach the voice-mail greeting.
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