MSSU Alumni Association

Missouri Southern Alumni - Membership Order Form

In Support of Missouri Southern State University

Online Payment Form

* Fields marked with an asterisk are required.
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Additional Options
MSSU uses PayPal services to process your credit card information securely.

Personal Information

*First Name:
*Last Name:
Maiden Name (If Applicable):
*Birth Date (MM/DD/YYYY):
Class Year (If Applicable):

Spouse's Information

First Name:
Last Name:
Maiden Name (If Applicable):
Birth Date (MM/DD/YYYY):
Class Year (If Applicable):

Contact Information

*Zip Code:
*Choose the Membership Type:

Amount to pay: $
For the Life Memberships, you can pay the full amount or make one of the yearly payments.
Billing will be handled through the MSSU Alumni Office.