Membership Form

Our membership year run from July 1 through June 30. Please fill out the form below when you pay your dues so that we can accurately capture your contact information and determine your interest in working on various committees. 


 

First Name *

Last Name *

Address 1 *

Address 2

City *

State * Select one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Email *

Phone

Month/Year of Birth

Membership Status * Select one New Member Renewal

Did You attend Norfolk State

Yes

No

Did you Graduate Select one Yes No

What years did you attend

What areas are you interested in?

Fundraising

Recruiting new members

Engaging current and potential students and their parents

Serving on Scholarship Committee

Working on community service projects

Working with social media and technology

Submit