(Please print your information)

Name________________________________________

Address_________________________________________

City___________________________________State__________

Zip___________Phone___________________

E-Mail:______________________________________________

Please circle your status:     Alumnus  *  Parent of student athlete   *

*     Friend of the OSU Lacrosse

PLEASE CHECK YOUR DESIRED TYPE OF 2008-2009 MEMBERSHIP:

_____Student Membership $15.00

_____Individual Membership $25.00

_____Family Membership $35.00

_____"Man Up Club " Membership $100.00

_____ Other in the amount of $_____________

THANK YOU FOR SUPPORTING OSU LACROSSE.
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