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 _______________________

(spouse, child, etc.)

DUES: ________ Life Member ($100.00) _______ Regular Member ($25.00 Annually)

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 _________________________________________ Email Address ____________________________

Rev 10-06