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NC TRIO Membership Form
Fiscal Year 10-1-2021 through 9-30-2022
Tax ID# 56-2221815
Amount due on or before 10-01-2021: $50
Amount due after 10-01-2021: $80
This fee is included in your registration for NC TRIO Conferences. If you are planning to register for the Fall Conference or Spring State Meeting, you do not need to complete this form.
If you are not attending an NC TRIO Conference, then this fee is separate. You will need to complete this form in order to secure your membership.
Student Support Services
Ronald E. McNair
Upward Bound Math/Science
Educational Opportunities Center
Veteran's Upward Bound
Institution / Agency
City / State
Work Telephone #
Are you a TRIO Alum?
Date Started in TRIO?
Does your program currently have an organized TRIO alumni organization?
If Yes, is it currently in operation?
Membership fees must be paid before or with conference registration fees in order to receive member rates for the Fall Conference, Spring Meeting, or other NC TRIO events. **PLEASE MAKE CHECKS PAYABLE TO "NC TRIO" AND MAILED TO TREASURER HOLLIS AT THE ADDRESS BELOW.
Receipts will be sent when payment is received
Would you like NC TRIO to invoice you through PayPal?
Please note that a 3% fee will be added to the total
No, I will render a check to the address below to secure my membership
No, I am planning to attend the Fall Conference/Spring State Meeting and will pay my membership through that medium
Send payment or purchase order to: Dekendrick Murray - NC TRIO Membership Chair // North Carolina Central University - Director, Office of Student Accessibility Services // P.O. Box 19855-C // Durham, NC. 277077 // email: firstname.lastname@example.org
IMPORTANT NOTE: Before becoming a SAEOPP member, your NC TRIO dues must be paid. Thank you! PLEASE DO NOT send your SAEOPP dues to the address above!!! Visit
to process your SAEOPP dues.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of NC TRIO.