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DUES FORM

    ____ NEW MEMBER                                                   
    ____CONTINUING MEMBER

NAME(S): ______________________________________

ADDRESS: _____________________________________

_______________________________________________

______________________________________________

TELEPHONE NUMBER:_________________________

EMAIL ADDRESS_______________________

DUES FOR THE ACADEMIC YEAR (2013-2014) :  $10.00 PER PERSON. 

                                                                                                     
PAYMENT ENCLOSED --------------------       

WRITE CHECK PAYABLE TO EMERITUS ASSEMBLY, AAUP AND MAIL TO JERRY LEIBOWITZ,  TREASURER, 28 WILLOWBROOK ROAD, STORRS, CT 06268
RESERVATIOM FORM

TUESDAY, APRIL 15, 2014

THE UNIVERSITY OF SAINT JOSEPH ART GALLERY
WEST HARTFORD, CT                                                                                            NO.__________
LUNCH AT THE UNIVERSITY CAFETERIA IS SELF PAY



TUESDAY, MAY 13, 2014

THE WEBB-DEAN-STEVENS MUSEUM 
WETHERSFEILD, CT       ($10.00 PER PERSON)                      
LUNCH AT A LOCAL RESTAURAT  IS SELF PAY                                           NO. _________

Please reserve by May 6, 2014 for the above meeting and include your payments by check..                                                                               
NAME(S): __________________________________________

ADDRESS: _________________________________________

___________________________________________________

___________________________________________________

TELEPHONE NUMBER:_______________________

EMAIL ADDRESS:____________________________

WRITE CHECK PAYABLE TO EMERITUS ASSEMBLY, AAUP AND MAIL TO  JERRY LEIBOWITZ, TREASURER, 28 WILLOWBROOK ROAD, STORRS, CT  06268