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Central
Carolina Club Membership Form for 2007 - 2008
Please download this
form, fill it out and mail it, along with with dues payment, to:
Laura Niemi '78
101 Stanley Court
Cary, NC 27513Please
supply all
information as you
wish it to appear on the Club roster. Please print or type:
Name 1_________________________________Class________Cornell
ID# _____________
(see mailing label)
Home
Address __________________________ City ___________
State ______Zip________
Work
Address __________________________ City ___________
State ______Zip________
Name
2_________________________________Class________Cornell
ID# _____________
(see mailing label)
Home Address __________________________
City ___________ State
______Zip________
Work
Address __________________________ City ___________
State ______Zip________
E-mail Address _________________________
E-mail Address 2 _______________________
Send
mail to: __Home __
Business __
Check here if you do not want to be listed
in the Club directory
MEMBERSHIP
DUES:
I am
enclosing a check for annual membership
dues, payable to the Central Carolina Cornell Club,
for:
Recent
graduate: 1 to
5 years (Classes of 2003 - 2007)
$20.00 $ ______________
Alumni
$30.00
$ ______________
Couple
(Two
Cornellians, or one Cornellian and spouse)
$45.00 $ ______________
Retiree
or parent of
current Cornell Student
$20.00 $ ______________
Club
Patron (To assist in Book Awards, CAAAN expenses and assist
$100.00 $ ______________
in underwriting club events)
Lifetime Membership
$250.00 $ ______________
I would also like
to contribute
to the Club's operating fund by including $ ______________
Dues Amount Enclosed $ ______________
SCHOLARSHIP:
I am
enclosing a
separate check (payable to Cornell University) for the
Central Carolina Cornell Club Scholarship in memory of Judy C. Goetzl,
former club president. (Scholarship gifts are eligible for matching
gift funds and class and Cornell Annual Fund credit only when a
separate check is submitted, payable to Cornell
University.)
Scholarship Gift Amount Enclosed $ ______________
CORNELL ALUMNI MAGAZINE:
__ YES!
I'm interested in subscribing to
Cornell
Alumni Magazine. Please start my subscription and
have the magazine bill me
just $30 for a one-year subscription!
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