California State University Bakersfield Chapter

Membership Form

Name _________________________________________________________________

Address _______________________________________________________________

City, State Zip __________________________________________________________

E-Mail _________________________________________________________________

Telephone _____________________________________________________________

Permanent Address (if different from above)

________________________________________________________________________

Month and Year You Expect to Graduate ____________________________________

Are you interested in being an officer? _____ Yes _____ No

Dues for a calendar year are $50.

Deadline for Payment of Dues: Monday, October 27

Dues Period: November 1, 2008-October 31, 2009.

Please make check payable to CSUB PRSSA.

If returning by mail, send form and check to: PRSSA, Communications Department, BDC 226, CSUB, 9001 Stockdale Hwy, Bakersfield, CA 93311.

If turning in form and check in person, take to BDC 248 at CSUB.

For Office Use

Amount Paid: ____________________________

Date:___________________________________

Dues Period:

Paid By: _____ Check Number ______________ _____ Cash

Collected by:____________________________________________________________