Alumni Association dues statement

Geisinger Medical Center School of Nursing
Dues Statement for GMC Alumni Association
Fiscal Year: Sept. 1, 2012 to Aug. 31, 2013
Please send dues by Oct. 31, 2012

Please complete:
Name __________________________________________________
             (First)                (Graduation)                         (Married)

Spouse's Name ______________________

Address  _____________________________
            
              _____________________________  (Street, RR, Box #)

Town________________________________State ______ Zip Code________ -_____

Telephone #_______________________

E-mail Address__________________________________ (Shared only with classmates if given)

Class of________________

Dues:_______$5 per year

General Alumni Fund:___________ (Donation enclosed)
(Used by Alumni Association to meet yearly obligations)

If your last name has changed since you received your last mailing, please fill in this blank with your previous mailing name: __________________________

Honorary Members (those who have received notification) - No dues required
Please contact Nancy or Margaret if you have questions about your honorary status.

Make all checks payable to Nurse's Alumni Association.
Mail to:
Mrs. Nancy Doran
210 Welsh Road
Danville, PA 17821

egdoran@verizon.net

Please send address changes, name changes and news to:
Margaret Franklin
311 E. Center Street
Danville, PA 17821
MJF5171922@AOL.com

If you use our e-mail, please identify yourself as an alumnus or mail may not be opened.