____ NEW MEMBER
____CONTINUING MEMBER
NAME(S): ______________________________________
ADDRESS: _____________________________________
_______________________________________________
______________________________________________
TELEPHONE NUMBER:_________________________
EMAIL ADDRESS_______________________
DUES FOR THE ACADEMIC YEAR (2010-2011) : $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
ELECTIONS 2010: STATE AND NATION (REITER & hADKY)
OLD STATE CAPITOL BUILDING RM 310 APRIL 5, 2010 NO.__________
LUNCH AT LEGISLATURE OFFICE CAFETERIA APRIL 5,2010 NO.___________
CONNECTICUT COLLEGE ARBORETUM ON MAY 18, 2010 NO.__________
LYMAN ALLYN ART MUSEUM ON MAY 18, 2010 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