Delaware State University Alumni Affairs

Delaware State University
Alumni Association, Inc.
Membership Application

Count me in. I want to help guarantee DSU's future by becoming an active alumnus/na.
Please complete the Membership Application Form below, and forward it by clicking the Submit button at the end of the form. Mail check or money order for the amount corresponding to the type of membership selected.

Please select type of membership:

	Annual Membership	$25.00
	Life Membership	$500.00
	Life Member Subscriber $50.00 deposit required
	Other

Payment Enclosed: Amount $

Make checks payable to:
D.S.U. Alumni Association, Inc.

PERSONAL INFORMATION
Name:
First Name: MI: Last Name:

Phone: Fax:

E-mail Address:

S.S. Number: Class Year:

Please provide the following information for our records:
EMPLOYER INFORMATION
Current Employer: Position:

Address:

Business Phone:

BUSINESS INFORMATION (Please complete if self-employed for Member Business Directory)
Business Name:

Position Title:

Address:

Business Phone:

Business Fax:

E-mail Address:

World Wide Web URL:

Keep Us Informed
(Please complete this section if your selected membership type is Other)

Business Description of Products / Services
(Approximately 60 words or less)

NOTE: This form may be printed, filled-in and mailed to address below.

Home Page

Chapter Directory

Activities & Events

Programs

Member Business Directory

E-mail

bar

Office of Alumni Affairs
Delaware State University
1200 N. DuPont Highway
Dover, DE 19901
Please Call: 302.739.5178 Fax: 302.857.6052
or click here to E-mail the Alumni Affairs Office

Copyright © 1997-2000 All Rights Reserved.

Web Site created & maintained by

	Home Page		Chapter Directory
	Activities & Events		Programs
	Member Business Directory		E-mail