| Name
__________________________________________
Complete the following only if you are a
new member or if you wish to change any information in our
current directory.
Address______________________________________
Phone ________________________________________
Email _________________________________________
Former occupation ______________________________________________
Current activities_________________________________
Interests________________________________________
Annual dues enclosed:
________ $25 individual membership
________ $40 couples membership
_______ Check (payable to Syracuse University)
_______ Visa
_______ MasterCard
Card # ______________________
Exp. Date ____________________
Signature ______________________________________
Please return to:
Institute for Retired Professionals
700 University Ave.
Syracuse, NY 13244
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