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Membership Form Cornell Club of the Berkshires 2006-2007 ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● Please type or print: Name 1 _________________________ Name 2____________________________ CU ID# __________School/year______ CU ID#________ School/year_________ Home Address ______________________________________________________ Home Phone (_____)__________________ Email Address_______________________ Email Address 2________________ Employer Phone_____________________ Employer 2 ___________________ Employer Address_____________________ Employer Address 2_______________ City/State/Zip________________________ City/State/Zip__________________ Business Phone_______________________ Business phone_________________ Send mail to: ם
Home ם Business ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● ם
I am enclosing a
check for annual membership dues, payable to the Cornell in the Berkshires: $10 ________Recent Grads (1-5 years) or
parents of current Cornell students
$15 ________Young Alumni (5-10 years)
$20
_______ Alumni $30
________ Cornell Alumni Couple $50
________Sustaining Member $200 ________ Life Member Activities ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● I am
interested in working on the following committees: ם Program ם Hospitality ם Scholarship ם Publicity ם Membership Suggestions
for the club’s program ( events, speakers, activities, etc.)
: ______________________________________________________________________________________ Please return membership form and check made payable to Cornell Club of the Berkshires For more information or
additional forms, contact Laurie Schwartz
or
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