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In the interest of generating membership and activities, the Greater Charlottesville Chapter of the Penn State Alumni Association would appreciate your completing this survey.

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* 1. Are you currently a member of any Penn State alumni chapter?

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* 2. Would you be interested in joining the Greater Charlottesville Chapter?

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* 3. If yes to question two, would you be interested in serving on the board or being a board officer?

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* 4. Please check the types of activities in which you would like to participate:

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* 5. Would you be interested in participating on the communications, membership, publicity, or program committees? If so, please specify below.

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* 6. Would you be interested in participating in social, cultural, or athletic events? If so, please specify below.

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* 7. Would you be interested in helping to organize any of the above activities? If so, please specify below.

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* 8. Name:

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* 9. Year of graduation:

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* 10. Address:

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* 11. Phone number:

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* 12. E-mail:

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