MEMBERSHIP & RENEWAL APPLICATION                              (PLEASE PRINT)

I wish to renew my membership or join the AARP Campbell Area Chapter 5151.  I have included a check for my annual chapter dues of $25 per person which includes the Dispatch, our monthly
newsletter.  You have the option of receiving it either by regular mail or e-mail. Check a box below to indicate your preference.  I am currently a member of the AARP National Organization.

                   Send the Dispatch via (    ) Regular Mail.  Send the Dispatch via (   ) E-mail.

National No. (Required): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .          Expiration Date:. . . . . . . .

E-mail Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . Amount Paid  $ . . . . . . Check #. . . . . .

NAME:. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . (    ) New Member* (see below) 

ADDRESS:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .(   )Renewal

CITY:. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . STATE:. . . . . . . .  ZIP CODE: __ __ __ __ __ — __ __ __ __

PHONE: (. . .. . . .) . . .. . . . . . . . . . . . . . . .SIGNATURE:. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .DATE:. . . . . . . .

*How did you hear about us?  (  ) Friend, (  ) AARP Brochure,  (  ) Campbell Press,  ( ) Attended Mtg,  (  ) Other: _____________

Age Group: 50-65 (  )  66-75 (  )  76+ (  ) 

Make checks payable to “AARP Campbell Area Chapter 5151;”

Mail to: Membership, 1172 South San Tomas Aquino Road, Campbell, CA 95008