First Name: Last Name:

Maiden Name:

Address:

City: Schenectady Scotia Niskayuna Delanson Albany Clifton Park Quaker Street Rexford Saratoga Springs Troy State: New York Zip:

Class Year: Undergraduate

Class Year: Graduate

Phone Number: E-mail address:

I would like to volunteer at St Clare's: Info Desk (Tues) Gift Shop (Thurs)

$10 Due Enclosed

Additional donation to Quinn Fund:

Send Dues To: Mary Lang

8 Birch Dr

Albany NY 12203