Membership Information Form

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Please complete the following form and return it with your dues ($20 payable to “USC Women’s Club”) to Dorothy Kendall at PO Box 2767, Columbia, SC 29202-2767.
 

_______ NO CHANGES       _______ CHANGES AS INDICATED

Membership Category (check): 
[   ] Newcomer      [   ] Renewal      [   ] Non-voting

Member's Name: ______________________________ Member's Dept.:____________________

Spouse's Name: ______________________________  Spouse's Dept.:____________________
(put * if deceased)

Mailing Address: _______________________________________________________________

E-mail address:  _______________________________________________________________

Telephone: ___________________________ (home) ____________________________ (other)
 

Note: Dues must be received by October 15, 2008 for members to be included in the yearbook.