CSU New Membership or Renewal

Name _____________________________________      Additional Family Members:

Address __________________________________      Name              Sex   Birthdate    Section

__________________________________________      ________________  ___   __ /__ /___  _______

City _______________ State ____ Zip ______      ________________  ___   __ /__ /___  _______

Phone (H) ___________ (W) ________________      ________________  ___   __ /__ /___  _______

Email: ___________________________ (optional)   ________________  ___   __ /__ /___  _______ 

Birthdate ____ / ____ / _____                   ________________  ___   __ /__ /___  _______

Signature ________________________________  

Section(s) you are joining: _______________________________________________

Type:    new membership	  	renewal  (circle one)

Subtype:  individual	     	family   (circle one)

Year(s): ______________  or   lifetime	             

Basic Membership    $ ____

Additional Sections $ ____

Total Enclosed      $ ____ (Make checks payable to CSU)

T-Shirt Size (new members only):  S   M   L   XL	(circle one)

Please return application to: CSU, 23 Fayette Street, Cambridge, MA 02139