Directions: Print this page. Fill out the form. Enclose your check made out to Sacramento State Emeritus Association and mail it to:

Steve Gregorich, Secretary
5193 Metate Trail
Placerville, CA 95667


Mail-in reservations must be received by November 1. If you are too late for that date, call Steve Gregorich at (530) 621-4505 to arrange to pay at the door.

RESERVATION FORM
Emeritus Association Fall Dinner
Friday, November 6, 2009 Alumni Center
No-Host Bar 6:00, Dinner 7:00, Entertainment 8:00 P. M.

Your name

Your Address  

Email  Phone Number

In which department on campus did you work? 

I want to begin renew membership for 2010.

Check one of the dues options below:

Faculty $30 Faculty Life $300 Faculty out of area 75 mi.or more $10
    Staff $20     Staff Life $150    Staff out of area 75 mi. or more $10

We will make name tags for you and your guests. Please list their names in this box:

*$40 for member and $40 for 1companion =
$50 each for non-members =
Your 2010 membership dues =
**Event Donation =
Total amount enclosed =

  *If you paid your membership dues for 2009, the cost of the dinner for you and for 1 companion is $40 each. Guests who have not
    paid  membership dues for 2009 pay $50 each for the dinner.
**Event donations help to pay for table wines, door prizes and the entertainment.