2012-13 Membership Form

Member 1

Name______________________________________________   E-mail address __________________________

Mailing address _____________________________________________________________________________

Home telephone number (including area code) ____________________________________________________

Work telephone number (including area code)_____________________________________________________

Graduating class and degree ____________________   Post-graduate class and degree _________________

Occupation and employer _____________________________________________________________________

Spouse (if not a joint member) _________________________________________________________________            

Children (names and dates of birth) _____________________________________________________________

Member 2 (if joint membership)

Name______________________________________________ E-mail address __________________________  

Work telephone number (including area code)_____________________________________________________

Graduating class and degree ____________________    Post-graduate Class and degree ________________

Occupation and employer _____________________________________________________________________

I am interested in:

___    Assisting with recruiting new students                          ___    Annual golf outing committee      

___    Membership committee                                               ___    Chapter social functions  

___    Assisting local alumni with job searches                      ___    Scholarship committee

Other (all ideas welcome) ______________________________________________________________________

Total amount enclosed:           

                        $_________*   Check #  ________   Date  __________

                                    *Individual membership is $15.00/year. Joint membership is $25.00/year.

Please make checks payable to “Cape Fear WVU Alumni Association” 

Please mail completed forms and checks to the Chapter President:

Cameron Simmons, 1527 S. Shore Drive, Surf City, NC 28445
capefearwvualumni@hotmail.com