Name:_________________________________________________

Local Address:__________________________________________

_______________________________________________________

Phone Number: (______)_______________________

Email Address: ______________________________

Please select one:
___New Membership ___Renewal Membership

___I am willing to aid in the planning of field trips, guest lectures, social events, etc.

___ Are you interested in serving as an officer? 
If so, which position are you most interested in?
___President   ___Vice President   ___Treasurer   ___Secretary   ___PR & Social Chair

___I have suggestions for student chapter activities. (please write on back of form)

Annual Dues:  $10
Make check payable to: S.A.A. W.S.U.

Complete and return to:
Wright State University
Department of History
ATTN: S.A.A.
370 Millett Hall
3640 Colonel Glenn Highway
Dayton, OH 45435-0001