______________________________________________________________________________
 Name (please print)

______________________________________________________________________________
 Spouse’s Name (if you want a joint membership)

______________________________________________________________________________
 Mailing Address

______________________________________________________________________________
 City                                  State                    Zip

______________________________________________________________________________
 Business Telephone                                   Home Telephone

_____James B Jewell___________________________________________________________
 Name of Person Recommending Membership (if applicable)


 Enclosed is my check payable to Purdue Alumni Foundation in the amount of:

     _______    $10,072                  Champion (one 2000-01 in-state scholarship)

     _______    $ 7,500    - champion    Olympian

     _______    $ 2,500    - $ 7,499     All-American

     _______    $ 1,000    - $ 2,499     MVP

     _______    $   500    - $   999     Captain

     _______    $   200    - $   499     First Team


 I / We would like to pay in _____ installments of $_____ each

 I / We would like to charge the gift to  Visa  or  Mastercard (circle one)

_______________________________________________________________________________
 Account Number                                           Expiration Date

_______________________________________________________________________________
 Signature

 Mail to:  John Purdue Club                  or call: 1-800-213-2239

           1790 Mackey Arena

           West Lafayette, IN 47907