MEMBERSHIP APPLICATION

PART 1: The Appliclation Form: Click the mouse image on your right to download and print a copy of the membership application form:   OR Complete the On-line application form below: Membership Period   Select One 1 Year - $25 2 Years - $40 ST. ROSE'S ALUMNI ASSOCIATION USA (NEW YORK CITY) Membership Application PART 1    Alumni Membership & Sponsorship First Name Last Name Maiden Name (if applicable) Street City State/County Postage Code Year Graduation School House Lima Loreto Select One Merici Brescia Cologne X Y Z Home Telephone Work Telephone Email Address Occupation PART 2    Associate Membership First Name Last Name Maiden Name (if applicable) Street City State/County Postage Code Email Address Occupation Home Telephone Work Telephone PART 3    Agreement I affirm , that if accepted as a member of the St. Rose's Alumni Association USA (New York City) I will not show, tell, copy, give, sell, review, change or dispose of any confidential information, unless directed to do so by a member of the Executive Board.  If directed to do any of these tasks, I will follow the correct procedure to assure confidentiality. In agreement, selecting the Submit button below serves as your signature.             **********   PART 2: Completing the form: 1. Parts 1 & 3 must be completed by alumni and Sponsoring Alumni for Associate Membership. 2. Parts 2 & 3 must be completed by the person applying for Associate Membership. ********** PART 3: Payment: 1. Send the completed form, accompanied by a Check or money order payable to St. Rose's Alumni Association USA (NYC), to the following address: St. Rose's Alumni Association USA P.O. Box 22321 Brooklyn, NY 11202-2321 Attn: Membership Committee OR 2. Make your payment on-line as set out in Part 4 below. ********** PART 4: Electronic Payment via PayPal: Pay Here: 1 Year Membership ($25) USD 2 Year Membership ($40) USD (No refunds) Return To Top