North Georgia College & State University
Alumni Association Membership Program

Annual Membership Application

Print this form and mail to:

NGCSU Alumni Center, 70 Alumni Drive, Dahlonega, GA 30533

Payment Type:

Checks should be made payable to the NGCSU Alumni Association.

If you would like to charge your dues we accept VISA, MasterCard, and American Express.

Card Type: ________________ Card #: ________________________ Exp. Date: ___________

Total Amount: _____________ Card Holder Signature:______________________________________

Membership Category:

Check applicable category
Annual Dues ___$25 Individual ___$35 Joint
Over Age 65 ___$10 Individual ___$15 Joint
Young Alumnus (classes of 2003-2007) ___$10 Individual ___$15 Joint
Class of 2008 ___ Free
 

Listing and Contact Information:

Name:____________________________________________
          (List as you want it to appear)

Class of________________
Spouse's Name:____________________________________
                       (List as you want it to appear) 		Class of_________________

 

Address_____________________________________________________________________________________________

____________________________________________________________________________________________________

Phone Numbers(s) (Required with credit card payment):

Home_________________________________

Business_______________________________

 
Email Address(s):_____________________________________________________________________________________