Membership Application
11/25/2009
All fields marked with
are required fields.
Membership Type (choose one):
Annual:
See options below
Individual - $50
Joint (2 persons at same address) - $60
Life:
*
See options below
Individual – $600
Individual – $300 (discounted rate only available to anyone 60 years of age or older)
Joint – (2 people - same address) $750
Joint – Second person at same address – $150
(Choose only when second person is being added to an existing life membership.)
Personal Information:
Title:
Mr.
Mrs.
Ms.
Other:
First name:
Middle name:
Maiden Name:
Last name:
E-mail address:
Penn State ID#:
9
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:
If you would prefer to join by mail,
go to the printable membership application.
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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