Emeritus Dues

$15.00 ­ July 1, 2008 thru June 30, 2009

The dues are for the fiscal year of the college July 1 - June 30 of each year. Do to difficulties with tracking multi-year payments, please submit only one year's dues. Thank you.

Name:
_____________________________________________________________________________
Address:
_____________________________________________________________________________

_____________________________________________________________________________
Phone number:
_____________________________________________________________________________
E-mail address:
_____________________________________________________________________________
Business Office E-mail:
_____________________________________________________________________________
Signature:
_____________________________________________________________________________
Date:
_____________________________________________________________________________

If you would like to be included in the Emeritus directory and mailing list, please indicate your choice below. The directory is only for other Emeritus members and will not be given out to other organizations outside of Chemeketa Community College. The directory will include your name, address, phone number and e-mail address unless otherwise noted below. Please contact the Chemeketa Liaison or an Emeritus Board Member if you have any questions.

Please DO__________ DO NOT__________ include my:

_____________________________________________________________________________

(Ex: phone number or e-mail address)

Mail your dues and this form to:

Chemeketa Community College
Emeritus Liaison, 2/216
PO Box 14007
Salem, OR 97309-7070