05/20/2013

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 – $300 (available to two people at the same address who are 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.