Retired Faculty Association

University of Southern California

Membership Application/Renewal

 

 

 

MEMBER'S NAME (please print)  ____________________________

NAME OF SPOUSE ________________________________________

DEPARTMENT  ___________________________________________

HOME MAILING ADDRESS _________________________________

                                                _________________________________

ZIP CODE _________ - ­­­_______

PHONE  (____)  _____________

E-MAIL ____________________

 

Annual Dues (July I - June 30) @ $20.00                            $ _______

Additional Voluntary Contributions to RFA                       $ _______

Russell Caldwell Scholarship                                             $ _______

Total                                                                                       $ _______

 

 

Make check payable to “USC RFA” and mail to:

 

RFA Treasurer

USC Emeriti Center

3715 McClintock Avenue, GER 220

Los Angeles, CA  90089-0191