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Alumni Association dues statement

Geisinger Medical Center School of Nursing
Dues Statement for GMC Alumni Association
Fiscal Year: January 1, 2015 to December 31,2015
Please send dues by Oct. 31, 2014

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