THE YALE CLUB OF
SOUTHERN CALIFORNIA

July 2004 - June 2005 DUES FORM AND QUESTIONNAIRE

Please return to Yale Club of Southern California, PO Box 9664, Los Angeles, CA 90295

Name and address:

______________________________________________

______________________________________________

______________________________________________

Class year and degree: _________________________________

Phone numbers: home: ___________________ work: ___________________

Email address: ______________________________

Enclosed are the following Club dues (check one). Please make check out to "Yale Club of Southern California":

___ $100 Patron Member (Show your support for Club programs, receive special recognition)

___ $35 Year price for Member

___ $20 Year price for Recent Grad Member (Classes of '99-'03)

___ ***FREE*** New Grad Member (Class of '04) and Current Students ('04-'08)

An additional contribution of $ ________ is enclosed for the:

___ Yale Book Award/L.A.
___ Community Service Fellowship
___ Yale Scholarship Foundation/L.A.

Please check the email lists you'd like to be added to (you are automatically added to the general Yale Club email list with membership):

             ___ Yale in Hollywood
             ___ Community Service
             ___ Young Alum
             ___ Yale in Business
             ___ Sports Adventure

Please indicate those activities in which you'd like to take part:

___ Interviewing applicants for admission or otherwise assisting the Alumni Schools Committee (event planning).
___ Serving as a Yale Club board member, director or officer.
___ Occasionally assisting in event preparations.
___ Making your home available for a Club event.
___ Offering space at your office/club for board meetings.