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DUES FORM     ____ NEW MEMBER         ____CONTINUING MEMBER NAME(S): ______________________________________ ADDRESS: _____________________________________ _______________________________________________ ______________________________________________ TELEPHONE NUMBER:_________________________ EMAIL ADDRESS_______________________ DUES FOR THE ACADEMIC YEAR (2011-2012) :  $10.00 PER PERSON. WRITE CHECK PAYABLE TO EMERITUS ASSEMBLY, AAUP AND MAIL TO RICHARD P. WURST, TREASURER, 29 DONNEL ROAD, VERNON, CT  06066-2705

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RESERVATIOM FORM "In Search of the Grail Trail" with Kathleen McGrory, Ph.D.                  1877 Club, University of Hartford.  October 20, 2011 Please reserve by October 14,2011 for the luncheon                                    NO.___________                                (COST AT $20.OO PER PERSON) "The State Financial Crisis and its implications for Retirees"  by Ed Marth Rm 1A, Legislature Office Building, Hartford. November 15, 2011     NO.__________ Please reserve by November 10, 2011 Pay as you go lunch NO._____________                                                                                                          PAYMENT ENCLOSED  $____________                                                                                                                                                                                                                                                                                                                                         NAME(S): __________________________________________ ADDRESS: _________________________________________ ___________________________________________________ ___________________________________________________ TELEPHONE NUMBER:_______________________ EMAIL ADDRESS:____________________________ WRITE CHECK PAYABLE TO EMERITUS ASSEMBLY, AAUP AND MAIL TO RICHARD P. WURST, TREASURER,  29 DONNEL ROAD, VERNON, CT  06066-2705