Merced College Students Only

Name ______________________________ e-mail __________________________

Phone number ________________________________________________________

Career goal __________________________ ASMC sticker # __________________

My membership dues of $10 for the current semester are enclosed. ______________

I understand that membership in the Merced College Pre-Medical Club is on a per semester basis and dues must be paid each semester by the due date in order to remain active. My photo may be taken during club activities and used in club publications, including the pre-medical club website.

I would like to organize activities and events. _______

Signature ________________________________________ Date ______________

Return to either: Mr. Carl Estrella, Dr. Douglas Kain, or Ms. Mireya Macias, Biology Department, 3600 M Street, Merced, CA 95348.