Press Club of Metropolitan St. Louis CharitableSecure Order Form

Press Club of Metropolitan St. Louis

Membership Payment Form

Select the item(s) below that you would like to order. Your transaction will be confirmed by email.
Students and recent graduates (to age 25): Special new rate! ($ 25.00 each) Quantity:
University communication faculty: Special new rate! ($ 35.00 each) Quantity:
Retired ($ 40.00 each) Quantity:
Active ($ 85.00 each) Quantity:
Corporate Active (all 5 members) ($ 340.00 each) Quantity:
Lifetime ($ 500.00 each) Quantity:

GENERAL INFORMATION

First Name: Last Name:

Address:

City: State: Zip:

Country:

Phone Number:

E-Mail Address:

First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address: