MEMBERSHIP

Palm Beach County Chapter of Florida A&M Alumni Association

Make all tax-deductible checks payable to: FAMU Alumni of Palm Beach County

Type of Membership:

____ Local/National( $70) ___ Associate Member ($70) ____Life Member ($750)

____Life Member (Paid in Full) ($35)

_____ Subscribing Life Member ($285 per year for 3 years)

_____ Student Life ($500 balance must be paid 1 year from graduation)

_____ Student LIfe Subscription ($125 for 4 years)

***Please note, life memberships do not include local dues.

*** All subscribing life memberships must be paid consecutively

Name________________________________________________________________________

Year of Graduation_________________ E-mail Address______________________________

Address________________________________________________________________________

Home Phone________________________ Work Phone_______________________________

Cell Phone_________________ Place of Employment________________________________

Work Address___________________________________________________________________

Check the committee(s) you are interested in participating with:

_____Auditing ____Fundraising ____Recognition ____Benevolence _____Hospitality

____Scholarship & Recruitment ____Calendar Drive ____Membership ____Spirit Committee

___Century Club ____Nominations ____Student Preview

Annual Contributions (Check One):

___$1,000 ___$500 ____$200 ____$100 ____Other

OFFICIAL USE

Please Do Not Write Here:

Membership Year:______________

Member Type:_________________

Amount of Dues Paid:______________

Type of Payment:_________________

Date:_________ Check Number:__________

Please print, fill out and mail the above application and corresponding payment to the Attention of Shayla Willingham to our mailing address.