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