Membership Form Cornell Club of Michigan

2001-2002           

BENEFITS OF MEMBERSHIP

Joining is simple! Just fill in the form below and click submit.

After submitting the form:
If you are mailing your payment, print two copies of the form, one for your records and one to mail. Send the completed form along with your check to:
Carey Jones '88
302 Garfield
Chelsea, MI 48118.
If you decide to use the online payment option, after you've submitted the form below you'll be presented with the appropriate link(s) to PayPal. Remember to print a copy of the completed form for your records.

Annual Dues (per family for the period September 2001 to August 2002)
  Enclosed is my check for annual membership dues, payable to the Cornell Club of Michigan, for:

Please Check One:
Individual Alumnus - $25
Parents of Current Student/Recent Graduate - $25
Cornell Alumni Couple - $30
Lifetime Dues - $195

Additional Contributions

Cornell Club of Michigan Scholarship
 

Please consider helping our Club endow a scholarship that will be awarded to a deserving student from Southeast Michigan each year. If you wish to make a gift to the scholarship fund, please include a separate check, payable to Cornell University. The separate check will ensure proper credit/accounting for matching gifts, Cornell Club of Michigan, Class and Cornell Fund.
 

I'm adding an additional payment for the Cornell Club of Michigan Scholarship in the amount of:
 

    $25
    $50
    $100
    Other
       Other Amount: $

Book Award
 

This program awards books authored by Cornell professors and alumni to Michigan high school students, to raise Cornell's visibility among prospective students. This is great public relations for Cornell--please support it with a check payable to the Cornell Club of Michigan.

Yes I am sending an additional $20.00 for the Book Award Program

Total Amount Enclosed:
     $

I'm interested in assisting the club with the following activities:
 

Scholarship Fundraising
Meeting with Prospective Students
Event Planning

Check the appropriate response below, dependent upon your wishes:
 

Please do not include my name in a CCM membership directory.
Please do not send me E-mail notifications regarding CCM events and activities.

 Personal Information:
First Alumnus: Required. Enter First, Middle, Last
 Class: College/Unit:
Second Alumnus: Enter First, Middle, Last
 Class: College/Unit:
Address: Required.
 
City: Required.
,		 State: Zip Code: Required.
Employer/
Profession:
Day   
Phone:
Evening Phone:
E-mail: Required.



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