_______________________________________ | _______ | __________ | |
Name | Class Year | Maggot # | |
_____________________________________________________________________ | |||
Street Address | |||
_____________________________________________________________________ | |||
_______________________________________ | _____ | __________ | |
City | State | Zip Code | |
_______________________________________ | |||
Telephone Number | |||
http://___________________________________ | ______________________ | ||
Web Site | E-mail Address | ||
_________________________________________ | ______________________ | ||
Instant Messaging Service | Instant Message Address | ||
Please allocate my donation to Nu Alpha Phi as indicated: |
$__________ | 2007 Dues ($10/yr) | ||
$__________ | Back Dues | ||
$__________ | Wash Fund | ||
$__________ | General Fund | ||
$__________ | Nu Alpha Phi Memorial Scholarship Fund, in the name of: | ||
____________________________________________ Write a separate check for Scholarship Fund donations to receive a prompt and proper IRS receipt from Pomona College. Scholarship Fund donations count toward alumni gifts, class gifts, and membership in the Associates, Torchbearers, etc. |