Application Form

___ Yes, I want to be a member of CUGALA
    Enclosed are my dues for the upcoming year.

___ $15 New York Metro        ___ $10 National (outside NYC)
    ___ Free (for current graduating class)

    ___ New Member ___ Renewing Member

___ I wish to offer this extra support for CUGALA activities.
    Thank you!

___ TOTAL enclosed (Make check payable to CUGALA).

    Mail to: CUGALA, PO Box 875, New York, New York  10156.


    ___ I do not wish to join today, but 
        Please ADD me to the MAILING LIST.
    ___ I will consider sending my membership dues.

Name   _____________________________________________________
Class  ______ College ______________________________________
Address ____________________________________________________
City, State Zip ____________________________________________
Phone (home) _____________________ (work) __________________
E-mail: ____________________________________________________
Significant Other Name: ____________________________________
Class (if Cornell)  ____ College ___________________________
 
I am interested in the following:
___ CUGALA Newsletter        ___ Activities in my local area
___ Helping w/Planning Committee ___________________________
___ Homecoming Events (Fall)       ___ Reunion Events (June)
___ Serving on the Board of Directors
___ Other __________________________________________________
          __________________________________________________

Please send a newsletter to my Cornell friends who
may be interested CUGALA:

1.
2.
3.
Include the following news about me in the next CUGALA
    newsletter: ____________________________________________
    ___________________________________________________________