Membership Form

Please fill out the information below and submit it.  You will then be redirected to Support Fund (#315425) to make your $30 donation to join the society.

If you have questions regarding membership, please contact Doug Bloss at dbloss954@gmail.com!

    Name (required)

    Street address (required)

    City (required)

    State (required)

    Zip code (required)

    Phone Number (required) Ex:(614)123-2345

    Email (required)

    Years in the Stadium Scholarship Program. (required) Ex: 1999-2001

    Stadium Scholarship Program Location

    Stadium DormMack HallScholars East/West

    I would like more information on how to get involved with SSAS.

    YesNo