FANS Membership Form
Name____________________________________________________
Year Graduated/Dates Attended Cal Poly _________________________
Address_______________________________Phone_______________
City_____________________State__________Zip_________________
E-Mail____________________________________________________
If student, permanent home address_______________________________
__________________________________________________________
FANS Joint Membership – $40 per year OR $200 for LIFETIME
Spouse/Partner’s Name__________________________________
FANS and Cal Poly Alumni Assoc. Joint membership - $100 per year
Soc. Sec.#___________________Year last attended Cal Poly_____
Degree______Major________
Spouse/Partner’s Name___________________________________
FANS Individual membership - $25 per year OR $125 for LIFETIME
FANS and Cal Poly Alumni Assoc. Individual Membership - $55 per year
Soc.Sec. #___________________Year last attended Cal Poly_____
Degree______Major_______
Student membership - $10 per year or $50 for LIFETIME
(if tendered within twelve months of leaving Cal Poly)
Annual membership subscriptions received will be effective
through June 30, 2008
Make checks payable to FANS and mail to:
P.O. Box 3853, San Luis Obispo, CA 93403-3853
How did you hear about FANS? Through the Internet. Which site led you to FANS?__________________________
From a current FANS member. Member’s name (optional)______________________
From campus advertisement
Other _____________________________________________________________