SACRAMENTO
VALLEY ILLINI CLUB
MEMBERSHIP
FORM
Name(s):
________________________________________________
________________________________________________
Address:
________________________________________________
________________________________________________
Please
provide your updated e-mail address as this is the main method of
communication. Be sure to let us know when your e-mail address changes.
E-Mail
Address:
____________________________________________
Telephone: Work
__________________________________________
Home__________________________________________
There is a
one time membership to join the club. Members will receive discounts for club
events.
Membership Dues
$10 Individual
__________ $15 Couple
Make checks payable to: Sacramento Valley Illini Club
Please mail check and form
to: Sacramento Valley Illini Club
C/O: Laura Witzka
4970
Mistywood Lane
Shingle
Springs, CA 95682
Member of University of Illinois Alumni Association Y___ N ___
THANKS FOR YOUR SUPPORT