CLUB MEMBERSHIP: STEP 1

Step 1: Complete the following membership information form, then click "Submit." You will be redirected to the Club's payment page, where you can select your desired membership level and use PayPal registration page where you to make a payment.

Individual Membership Information:

* denotes required field.

*Name:
Maiden Name:
Cornell ID:
*Home Address:
*City:
*State:
*ZIP:
*Home Phone:
Employer:
Job Title:
Work Address:
City:
State:
ZIP:
Work Phone:
Fax:
*E-Mail:
*School:
*Class:

I am a Cornell Parent

My "significant other" is also a Cornell Alum

If you are registering for a "Couple" membership, please provide the following additional information about your "significant other":

Name:
Maiden Name:
Cornell ID:
Employer:
Job Title:
Work Address:
City:
State:
ZIP:
Work Phone:
Fax:
E-Mail:
School:
Class:

I/we DO NOT wish to have the following information included in the published directory: (name, address, phone, business, affiliation, position, school, class)

I/we DO NOT wish to have the following information included in the website directory: (name, school, class, e-mail)

For more information on the Cornell Club of St. Louis, or to participate in any of its activities, please feel free to contact us.