MAILING ADDRESS:

Name    ________________________________________________

Street    ________________________________________________

City, state, zip ____________________________   _____  ________-_____

home phone: _______-________-________

FAMILY MEMBERS

fam mem	Name	sex	birthdate	work or cell phone	email
1			/   /
2			/   /
3			/   /
4			/   /
5			/   /

SECTIONS: Check the sections selected by each family member. Also , for each section that is checked , please indicate whether or not the person will be registered with the appropriate body, and accredited to CSU, with a Y or N.

fam mem	Running	USATF/NE ?	Race Walking	USATF/NE ?	Skiing	NENSA ?	Orienteering	USOF ?
1
2
3
4
5

DUES: You can sign up for one or more years; just multiply the amount by the number of years. Or, you can sign up for life membership.

YEARLY MEMBERSHIP   Basic ($20/10/30)                        ______   Total sections         ___    less # of family members ___    = extra sections        ___ @ $3/1.50/4.50   ______   ANNUAL DUES                        ______       x  number of years            ____   TOTAL                               ______

LIFE MEMBERSHIP    Basic ($270)                          ______    Total sections          ___    less # of family members   ___    = extra sections        ___  @ $40         ______    LIFE DUES                      ______

Make checks out to CSU, and send to:
         Larry Berman
         23 Fayette St
         Cambridge MA 02139-1111

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