National Capital Chapter - Membership and Scholarship Donation Form

RELATED LINKS:

Membership and Scholarship Donation Form

2006 – 2007 Division A

Out of State Chapter of the Year

National Capital Chapter Dues ٠ Scholarship Donation ٠ Contact Information Update

Pay your dues using your credit card online at www.dcbamafans.com

NOTE: Memberships will now be processed on a “rolling” basis!

Please be sure your National Alumni Association membership is up to date

c New Member                                   c Renewal



Name:    ____________________________________Graduation Year (if UA): _____

Work Phone: ______________

Spouse (if joining): ____________________________Graduation Year (if UA): _____

Work Phone: ______________

Mailing Address-Street: _______________________________________________________________________

City, State, Zip: _______________________________________________________________________

Home/Cell Phone: ____________________________

E-mail Address: ______________________________

Second Email Address: __________________________

Beginning April 1, 2008, all Chapter newsletters will be distributed via email only, unless otherwise requested

c            Check here if you would like to receive the chapter newsletter in hard copy format.

                Please make sure you have included your name and address above

$______                Annual National Capital Chapter dues donation

                                _______$25 single        ________$40 couple/family

$______                Scholarship Donation: ___General Fund      ___Cronin    ___Dyess

                              ___Groom   ___ Rose    ___Tate ___Mason

$_______             Total Amount Enclosed - Make checks payable to the National Capital Chapter

(See Chapter mailing address below)

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Please indicate your interest in assisting the Chapter with the following activities:

c Student Recruitment    c Scholarship/Fundraising   c Social/Events     c Membership

c Sports                              c License Plates                     c Website Design & Updates

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If you are a new member, how did you hear about the National Capital Chapter?

c Alumni/Friend   c Web     c Capital Alumni Network   c UA/National Alumni Association

c Other (please specify):______________________________________

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Please email completed form to membership@dcbamafans.com or mail with payment to:

National Capital Chapter

P.O. Box 2671

Arlington, VA 22202

Have you signed up for your University of Alabama

Virginia, Maryland or Washington, DC License Plate yet?

Go to www.dcbamafans.com and click on the License Plate link to sign up