ECSU Magazine 2.1.pmd - Elizabeth City State University

Elizabeth City State UniversityNATIONAL ALUMNI ASSOCIATIONMEMBERSHIP APPLICATIONRecruitment Drive for Period Covering:January 1 - December 31, 2004Name ________________________________________________________________________________Address_______________________________________________________________________________City ____________________ State _____________ ZipCode ______________________Telephone No. ______________ Home ( )_____________ Work ( ) __________ Ext. __________E-mail ________________________ FAX __________________________________________________Type of Membership: ❑ Regular/Associate $30❑ Single Life $400❑Couple Life $720Prior year Alumni Chapter member: ❑ Yes❑ No If yes, Chapter Name ____________________Did you attend ECSU ❑ Yes ❑ No If yes, what year did you attend __________________________Did you graduate? ❑ Yes ❑ No If no, what year did you last attend___________________________Major ____________________________________ Degree earned ________________________________*If you are interested in joining a chapter, organizing a chapter, or need additional information regarding membership, please contactDR. JEANETTE H. EVANS, CHAIRPERSON TELEPHONE: (252) 335.3618ELIZABETH CITY STATE UNIVERSITY1704 WEEKSVILLE ROADELIZABETH CITY, NC 27909 FAX: (252) 335.3731EMAIL: JHEVANS@MAIL.ECSU.EDUPLEASE MAIL APPLICATION TO:alumni newsCampus Box 977 • ECSU, Elizabeth City, NC 27909Please use attached reply envelope to submit form(s).58 ECSU MAGAZINE FALL 2003