Questions: Mary Crittenden
Director of Membership
860-644-0254

Printable Application

Purdue Club of Connecticut - Membership Application Form

Name: ______________________________________ Degree: __________ Year: ______
PAA Member: Yes/No

Spouse: _____________________________________ Degree: __________ Year: ______
 PAA Member: Yes/No

Street Address: _____________________________________________________

City: ________________________________ State:_____________ Zip:_____________

E-mail: _________________________________________________________________

Children: _______________________________________________________________

Are you interested in helping with Club Activities? Yes/No
Would you like an application for PAA Membership?  Yes/No
Would you like a Purdue Alumni Kids Club Application?  Yes/No

Total Enclosed                                $__________