(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 which include our newsletter, The Dispatch. Membership fee is $17 with the Dispatch sent by regular mail. If you would like your Dispatch sent via e-mail, membership fee is $14, which includes a $3 discount, as we save on printing & mailing costs. I am a member of the National Organization.
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 our chapter? _________________________ Age Group? 55-65 ( ) 66-75 ( ) 76+ ( )
Please make checks payable to AARP Campbell Area Chapter 5151. Attend meeting on third Tuesday of any month at 9:30 a.m., Q80, Campbell Community Ctr., Campbell, CA