Membership Form 2018-2019

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First Name: Last Name:

Maiden Name:


City: State: Zip:

Class Year: Undergraduate

Class Year: Graduate

Phone Number:

E-mail address:

$10 Due Enclosed

Additional donation to Quinn Fund:

I am interested in ordering an Entertainment book for $25.00:

I am interested in volunteering for the Chapter:

Thursday afternoons(monthly) at the Gift Shop at Ellis McClellan Campus

Monday mornings(quaterly) at the Dominican Retreat House

Send Dues To: Nina Whitney

150 Sherman St

Schenectady NY 12303

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