Palm Beach County Chapter of
Florida A&M Alumni Association
P.O. Box 2305
West Palm Beach, FL 33402
MEMBERSHIP APPLICATIONMake all tax-deductible checks payable to:FAMU Alumni of Palm Beach County
Type of Membership:
____ Local/National( $70) ___ Associate Member ($70) ____Life Member ($750)
____Life Member ($35)
_____ Subscribing Life Member ($285 per year for 3 years)
_____ Student Life ($500 balance must be paid 1 year from graduation)
_____ Student LIfe Subscription ($125 for 4 years)
***Please note, life memberships do not include local dues.
*** All subscribing life memberships must be paid consecutively
Name________________________________________________________________________
Year of Graduation_________________ E-mail Address______________________________
Address________________________________________________________________________
Home Phone________________________ Work Phone_______________________________
Cell Phone_________________ Place of Employment________________________________
Work Address___________________________________________________________________
Check the committee(s) you are interested in participating with:
_____Auditing ____Fundraising ____Recognition ____Benevolence _____Hospitality
____Scholarship & Recruitment ____Calendar Drive ____Membership ____Spirit Committee
___Century Club ____Nominations ____Student Preview
Annual Contributions (Check One):
___$1,000 ___$500 ____$200 ____$100 ____Other
OFFICIAL USE
Please Do Not Write Here:
Membership Year:______________
Member Type:_________________
Amount of Dues Paid:______________
Type of Payment:_________________
Date:_________ Check Number:__________
