BLUE & WHITE SOCIETY
MEMBERSHIP ACTIVATION FORM

08/01/2014
GWS13

You must be a currently enrolled Penn State student to activate a membership in the Blue & White Society. All membership options
include a free BWS T-shirt (?) and access to more than 30 benefits and services. Please select only one membership option below.

* Indicates a required field.

Membership Type (choose one): (?) *

xxx(BWS Membership PLUS includes a mailed copy of The Penn Stater magazine to your preferred address)


Your Information:

Title:
First Name:
*
Middle Name:
Maiden Name:
Last Name:
*
Penn State Student ID#: (?)
*
Penn State Email Address:
*
@psu.edu
Alternate Email Address (Non PSU)*: (?)
Current Campus:
*
Expected Graduation Date:
Cell Phone*:

*By providing your cell phone and/or alternate email, you give the Penn State Alumni Association permission to use this information in order to fulfill
certain member benefits or communicate information about your membership.



Your Preferred Address (your member card and all membership materials will be sent to this address):

Street 1:
*
Street 2:
City:
*
State:
*
Zip Code:
*
This Address Is My:
*




Inactive hide details for Payment Information:Payment Information:




To qualify for student membership in the Penn State Alumni Association's Blue & White Society you must be a currently enrolled student at one of Penn State's campus locations. You can also join by phone by calling 800-548-LION, option 1.




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