North Georgia College & State University
Alumni Association Membership Program

Lifetime 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:

I want to become the next North Georgia College & State University Alumni Association Lifetime Member. Enclosed is my

___$400 one-time payment for individual Life Member or

___$550 one-time payment for joint Lifetime Members

made payable to the NGCSU Alumni Association.

Payment Plans: (First payment due with application.)


_______ Split Payment Plan - Make two annual payments to equal total Life Membership Dues.

_______ 5-Year Payment Plan - Make five annual payments to equal total Life Membership Dues.

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):_____________________________________________________________________________________