Student Activities Card Application
(fill out, print, and mail to the address below)
NAME
ADDRESS
NUMBER STREET
CITY
STATE ZIP
PHONE NUMBER
Please check appropriate:
FEMALE MALE
55 OR OVER UNDER 55
Signed
_________________________________________
New Renew
You may personally apply at EMERITUS CENTER, COLLEGE OF MARIN, Kentfield, CA 94904, Monday-Friday, 9:30 am-3:30
pm, or mail this application enclosing a $12 check or money order and self-addressed, stamped envelope to the above
address. Checks should be made out to Associated Students of Emeritus College.
ASSOCIATED STUDENTS OF EMERITUS COLLEGE OF COLLEGE OF MARIN