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SSUNAA-Class of 1976 Chapter, Inc. Membership Form 2023
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* Indicates required question
Name
*
Your answer
Phone w/area code
Your answer
Street/PO Address
*
Your answer
City, State, Zip
*
Your answer
This form automatically collects your email. You may provide an alternate Email Address or mark NA.
*
Your answer
My choice for membership is
*
Annual Member $70
Prestigious Life Member $1500
Standard Life Member $1000
Associate Member $70 ( Non-Alumni Friends, family, and other supporters)
Unchanged-Current Life, Prestigious, or Diamond Life Member
Diamond Life Member $2500
Other:
Membership or Pledge Payment Plan
*
Monthly
Quarterly
Semi-Annually
Total One-time
I am not interested in membership at this time, but will
*
Pledge $450 to the 2021 Endowment, payable in installments
Pledge other amount
NA; membership choices are noted above.
Pledge at another time.
Other:
I hold membership in another chapter
*
Yes
No
Other:
If yes, please identify the chapter and type of membership.
Your answer
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