The NCCU Sound Machine
Booster Club

Post Office Box 72212 - Durham, North Carolina 27722
E-mail: NCCUsmbc@yahoo.com

Application of Membership

Date:_____________________________________

  MR.() MS.() MRS.() DR.() REV.()

NAME:_____________________________________ ____ ________
 

Last - First - Middle

ADDRESS: _________________________________________________

CITY:_____________________________________ STATE:_________________________
Zip Code:_____________________________

Home Telephone:___________________________Work:_________________________

E-mail Address:_____________________________________

Personal Web Page: http://__________________________________________

Graduation Date(s):_______________________Degree(s):____________

Are You A: New Member () - Renewing Member () - Life Member () - Student Member () - Other Type Member ()        

*Please Indicate Your Areas of Service Interest*

Student Recruitment () Fundraising () Club Membership () Club Social Activities ()
Finance () News Letter () Scholarships () Band Concerts ()
Dinner Dance () Public Relations () Alumni Band () Band Logistics ()
Other Interest ()

Basic Membership Dues:         $25.00 Per Year ()
Patron Member: $100.00 Per Year ()
Band_Wagon Member: $250.00 Per Year ()
Life Patron Membership: $500.00 Life Time()
Student Member: $10.00 Per Year ()

*SPECIAL CONTRIBUTION*

I Would Like To Make A Special Scholarship Contribution In The Amount Of: $______________, IN Support of the NCCU Sound Machine Bands.

I would like to Purchase or Donate A Band Uniform(s) or the following type(s) of Musical Instrument(s) for the NCCU Bands.

_________________________________________________

Please Make Your CHECK or MONEY ORDER Payable To:

Sound Machine Booster Club
Durham Chapter - NCCU Alumni Association (written on the check's MEMO Line)

Or, if you prefer, you can make your CHECK or MONEY ORDER Payable To:

The NCCU Foundation,
c/o Sound Machine Booster Club (written on the check's MEMO Line)


You May Also Pay Your SMBC Contribution OnLine
Directly To Our NCCU Foundation Account
Please Click Here
To Pay Your SMBC Membership Dues
or Band Contribution OnLine

HOW WERE YOU CONTACTED?

News Letter () Internet ()
News Media () Other Alumni () By Whom: ________________________(Please Specify):

For Additional Information, Please E-mail us at: NCCUsmbc@yahoo.com

SMBC Home Page

Revised: 07-31-2004