PASADENA PLAYHOUSE ALUMNI & ASSOCIATES

Membership Application

NAME _______________________________________ MAIDEN NAME ________________________

ADDRESS _______________________________________ CITY ______________________________

STATE __________ ZIP _____________ PHONE _________________ FAX _____________________

E-MAIL ADDRESS ______________________________________

_____ ALUM – Year(s) attending the Playhouse _____________________________________________

_____ ASSOCIATE – Year(s) participating _________________________________________________

In what capacity? (i.e. Actor, Director, Employee) ____________________________________________

Or related to member _________________________ Relationship _______________________________

DUES: Life Member ($100) __________ Regular Member ($30 Annually) ____________

Honorary Yearlong Membership (Cast & Crew Only, $0) __________

Payment: Make checks payable to PASADENA PLAYHOUSE ALUMNI & ASSOCIATES

Mail to: PPA&A - P.O. Box 291 – Pasadena, CA 91102-0291

Referred by ___________________________________________________________________________

RELEASE:

_________ I DO _________ I DO NOT want my address listed in the Directory

_________ I DO _________ I DO NOT want my phone number listed in the Directory

SIGNED __________________________________

Additional Information or Comments:

Do you have a referral for possible membership?

Name ______________________________ Address __________________________________________

City/State ______________________________ Zip Code _____________________________________

Phone _____________________________ E-mail Address _____________________________________

Rev 8/09