Student Membership Application

*Indicates a required field.

MembershipType

Membership Type *

Membership Length *

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

Your Information

First Name *

Middle Name:

Maiden Name:

Last Name *

Penn State Student ID# *

Penn State Email Address *
@psu.edu

Alternate Email Address:

Cell Phone:

Current Campus *

Expected Graduation Date:

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.

Address 1 *

Address 2:

City *

State/Province *

Country (if not USA):

Zip/Postal Code *

Preferred Address Type *

Home/Permanent

Local/Campus

Parent(s)

Payment

Charge annual dues to my student account.

I authorize Penn State to charge my Blue & White Society annual membership to my student account. Any federal aid in my account may be applied toward these charges unless I rescind the authorization.

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 spirit scarf and access to more than 30 benefits and services.

You can also join by calling 800-548-5466.

Penn State Alumni Association, Hintz Family Alumni Center, University Park, PA 16802
800-548-LION (5466)

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