CSUSB Black Faculty Staff and Student Association Membership Form

Membership in the Black Faculty, Staff, and Student Association means being a part of an organization who supports students, promotes unity, and creates a village of people who connect and appreciate each other at all levels.  We are happy that you have chosen to expand our membership! 

We have several opportunities for you to join and become a member of BFSSA.  You have choices! 

Bronze Membership ($20) – this is our basic membership which includes your name in the membership section of the website, an association t-shirt, and your support of student scholarships. 

Silver Membership ($35) – this is our prime membership which includes all of the benefits of the bronze membership plus association notebook and pen. 

Gold Membership ($50) – this is our premier membership which includes all of the benefits of the bronze and silver memberships plus the addition of an association coffee mug. 

Friend of the Association – this category is for those who choose not be become a member but want to support student scholarships and the association in general.  You can donate any amount you wish! 

Please complete the information below and submit this form to Diana Minor at diana.minor@csusb.edu. 

Sign in to Google to save your progress. Learn more
Email *
First Name: *
Last Name: *
Title/Position:
Please Check One:
Student Id: 
Organization/Department:
Location on Campus:
Work Phone: *
Cell Phone (Optional):
Email Address: *
Type of Membership: *
We understand that you may want to participate at varying levels, so we are excited to bring you options for membership with BFSSA. 

Gold Membership- this is our premier membership which includes all of the benefits of the bronze and silver memberships plus the addition of an association water bottle. 

Silver Membership-this is our prime membership which includes all of the benefits of the bronze membership plus a signature association sticker and towel. 

Bronze Membership-this is our basic membership which includes your name in the membership section of the website, an association t-shirt, and your support of student scholarships.

Friend of the Association-the category is for those who choose not to become a member but want to support student scholarships and the association in general. You can donate any amount you wish!

Please visit this website to make your payment: https://www.givecampus.com/campaigns/22537/donations
Required
I would like to contribute an additional amount to support any staff/faculty member with their dues. 
Volunteer Committee Work: 
[If you have a committee you would like to serve on, please feel free to select an area.]
 *
Required
Print First and Last Name: *
I hereby apply for membership in the Black Faculty, Staff, and Student Association at California State University, San Bernardino and pledge to support its goals and objectives.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of California State University, San Bernardino. Report Abuse
Google Forms