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Alcorn State University National Alumni Association, Metro Atlanta Chapter, Inc. - Membership Form
Thank you for joining the Metro Atlanta Chapter. Please complete this membership form.
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First Name
*
Your answer
Last Name
*
Your answer
Middle Initial
Your answer
Maiden Name
Your answer
Spouse Name
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Email Address
*
Your answer
Contact Telephone Number
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Occupation
*
Your answer
Did you graduate from Alcorn State University?
*
Yes
Attended but did not graduate
Did not attend Alcorn
If yes, year(s) graduated
Your answer
If attended but did not graduate, year(s) attended
Your answer
How did you learn about the Metro Atlanta Chapter?
Your answer
What skills or expertise can you contribute to the Chapter?
Your answer
Would you be interested in serving on a Chapter committee(s)?
*
Yes
No
Maybe
Type of Membership
*
Annual $115 (local $65 /nationals $50)
Annual $65 (local only)
Life (new) $565 (local $65 /nationals $500)
Life (existing) $65
Exempt (70+ years old) $34.50
Exempt (recent graduate) $0.00 - 1 yr membership
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