OSULA MEMBERSHIP FORM

Please print, complete form and mail with a check for $20 made payable to OSULA to:

OSU-LA
7985 Santa Monica Blvd
Suite 109-586
Los Angeles, CA  90046

Name:_________________________________________________________________

Home Address:___________________________________________________________

City/State/Zip:____________________________________________________________

Home Phone:_____________________________________________________________

E-mail Address:___________________________________________________________

Company Name:__________________________________________________________

Occupation:_____________________________________________________________

Work Phone:____________________________________________________________

Degree(s):______________________________________________________________

Major(s):_______________________________________________________________

Graduation Year(s):________________________________________________________

Spouse’s Name:__________________________________________________________

Would you like to be on the volunteer list for various club needs (mailings, event help, etc.)? Circle One      Yes    Not at this time

Would you more information on becoming an OSULA Board Member?_______