Membership Application
Although many of these fields aren't required, it does help us better understand the Penn State population that we serve.  Please consider providing as much information as possible.

Sign in to Google to save your progress. Learn more
Email *
What type of membership have you decided on? *
Is this a new application or a renewal? *
First Name *
Last Name *
For Joint or Family Application, please provide the names of all other applicants. Single Applicants enter NA for Not Applicable. *
Street Address
City
State
Zip Code
Phone Number in (XXX) XXX-XXXX format as in (814) 867-5309
Where do you work? (City, State)
What is/was your occupation?
Relationship
Are you a member of the Penn State Alumni Association?
Clear selection
What's your Alumni Association member number?
Are you a member of the Nittany Lion Club?
Clear selection
Graduation Year
Campus Attended
Academic College
PSU related Clubs, Sports, Greek, other Chapters, or AIG Affiliations
Interests
If not already a subscriber, can we add you to our mailing list?
Clear selection
Starting 3/1/22, the Penn State Alumni Association (hereinafter "the Association") will be requiring each chapter to provide specific information to assist in their implementation of the new One Membership program. Based on this new program, chapters will be providing the following information: Member names, Membership category, (i.e. Alumni, Parent, Student, Friend), Email addresses, Graduation Year, and Alumni ID number.  The Association may share this information with contracted non-Penn State entities, third-party vendors, or service providers to provide services to you on our behalf or, in limited circumstances, offer ads that may be of interest to you. The Association may also offer opportunities for you to opt-in to receive information from non-Penn State entities. If you opt-in, you may receive correspondence from these organizations on programs, products, or services that might interest you. You will always have the opportunity to opt-out with these organizations directly by using their unsubscribe or opt-out process.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Potomac Valley Chapter of the Penn State Alumni Association. Report Abuse