Membership Summary Sheet and Payment Form
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Membership Summary Sheet and Payment Form
Alumni Chapter Name: Affiliate Number:
Alumni Chapter Address:
Alumni Chapter Contact Person:
Total Number of members paying ______at $3.00 per member. $______Total Amount Annual State dues: for Annual State Dues
Total Number of members paying ______at $10.00 per member. $______Total Amount Annual National dues: for Annual National Dues
Total Number of members paying ______at $50.00 per member. $______Total Amount State Life membership dues: for State Life Dues ** Please list names on back**
Total Number of members paying ______at $160.00 per member. $______Total Amount National Life membership dues: for National Life Dues ** Please list names on back**
Total Number of Subscriptions to ______at $2.00 per annual $______Total Amount FFA New Horizons member. for New Horizons Subscriptions
Grand Total Membership and Magazine $______Subscriptions
Please make checks payable to: North Carolina FFA Alumni Association NCSU Campus Box 7654 Raleigh, NC 27695-7654 Phone: 919-515-4206 Fax: 919-513-3201 STATE LIFE MEMBERSHIP Please list names of those paying State Life Dues
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NATIONAL LIFE MEMBERSHIP Please list names of those paying National Life Dues
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10. Alumni Chapter Leadership Form
Alumni Chapter Name: Affiliate Number:
Alumni Chapter Address:
Alumni Chapter Contact Person:
Please list your FFA Alumni chapter officers
______, President
______, Vice President
______, Secretary
______, Treasurer
______, Council Member
______, Council Member
______, Council Member
______, Council Member
______, Council Member
______, Other Officer ______
______, Other Officer ______
______, Other Officer ______
When does the term of service expire for these officers? ______Date