Membership Registration Form
Stanford Club of Philadelphia
Please send check made payable to “Philadelphia Stanford Chapter,” and mail with this registration form to: Stanford Club of Philadelphia, P.O. Box 58191, Philadelphia, PA 19102. Questions? Call Mike Borish at 215-672-2827 (home)
Name: ___________________________________________________________________________________________
Stanford Graduation Year and Major (or name of student(s), if parents): ________________________________________
Address:__________________________________________________________________________________________
City:___________________________________ State: _______ Zip Code: ______________
Phone (Day) :_____________________________________
Phone (Night): _____________________________________
Fax: ____________________________________________
E-mail: __________________________________________
Company Name: __________________________________
Job Title: _______________________________________
Business Address: ________________________________________________________________
City:___________________________________ State: _______ Zip Code: ______________
Spouse/Partner Name: ___________________________________
His/her Degree, Class Year (if Stanford): ________________
_____ Yes, I would like to help plan future Stanford Club of Philadelphia events!
Dues are $10 for Young Alumni (Class of 2005-2009) and $15 for an individual or household membership.
Special Rates: A 3-Year membership for Young Alumni at $25, or a 3-Year individual or household membership at $40.