2010 LSU Austin Alumni Chapter Membership Form

Membership is open to anyone who bleeds purple and gold! Please mail in this form, with your $10 check payable to LSU Austin Alumni Chapter, to Will Washington, 13420 Tossa Lane, Austin TX 78729. The information on this form will be used for our membership directory. Dues are valid from January through December 2010.

CURRENT INFORMATION

___ $10 per Member Name: _____________________________________________________
Maiden Name: _________________________Spouse’s Name __________________________
Children's names and ages: _______________________________________________________
Home address: ________________________________________________________________
City _________________________State: _____________________Zip: _________________
Preferred e-mail: ______________________________Home phone: _____________________
Should we add you to the e-mail list? Yes______ No_______
How long have you lived in Austin? _______Where did you move here from? _____________

ALUMNI / ALUMNI-BY-CHOICE INFORMATION

Hometown (please include state): ________________________________________
High school/city/state and year of graduation: ________________________________
Are you an: _____ LSU Alumni or ______ LSU "Alumni by Choice"
If "Alumni by choice", other college(s) attended: _____________________________
Years attended: ____________ Degree and Year: __________________________
Anything else you'd like to mention:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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HAVE A BUSINESS? Tell your fellow Austin Tigers about it! (Sponsorships are good for the 2009 calendar year)

White Level ___ - $20: Check here if you would like to have a link to your business on our supporter page, and include an extra $20 with your $10 membership fee!

Purple Level ___ - $50: Check here if you would like to have a business logo link on our supporter page, along with a listing in the once a year newsletter, and include an extra $50 with your $10 membership fee!

Gold Level ___ - $100: Check here if you would like to have a LARGE logo link on our supporter page, along with a listing in the once a year newsletter, and include an extra $100 with your $10 membership fee!

Are you not looking for a business sponsorship - but instead a personal sponsorship? Yes____ No____

TOTAL ENCLOSED: $_________, CHECK #: _________, DATE: _____ OR CASH _______