Member Registration form revised

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					                             Advancing the Profession and the Future Professional
                                  Explore, Expand, Excel With CSUF PRSSA!
                                     Robert E Rayfield Chapter
                                California State University, Fullerton
                                  Membership Registration Form
SEMESTER:

Name:                                                                                  Date:
Address:
City:                                                                         ST:                       Zip:
Phone:                                                                                 Birthday:
Email:
Expected Year of Graduation:
How Did You Hear About Us:                        Class          Faculty          Flyer
    Friend (Other PRSSA Member) Name:
    Event Name of Event:                                      Other (Please Specify):
By signing this form I agree to pay the full amount due, $80 by the second Wednesday of October for
  the Fall Semester or the second Wednesday of February for the Spring Semester and I understand
                 that if this amount is not paid by this date my membership will be forfeited.


Signature:                                                                             Date:
       Please make check or money order in the amount of $80 payable to:
                                                             PRSSA
  Please submit payments at our meetings to the Finance Director, or in our
                  mailbox #167 on the 2nd floor of the TSU.
                             *The $80 payment is for two (2) semesters of membership.
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                                    TO BE COMPLETED BY A BOARD MEMBER
                                         (RETAIN THIS PORTION FOR YOUR RECORDS)
DATE PAID: __________________________                                         AMOUNT PAID: ________________________

PAYMENT METHOD:                   CHECK #: ___________________                         MONEY ORDER

COLLECTED BY: _____________________________________________________________________________

                                                                                    email: prssa_csufullerton@yahoo.com

				
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posted:10/5/2012
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