Alabama A&M University Alumni Association, Incorporated
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ALABAMA A&M UNIVERSITY ALUMNI ASSOCIATION, INCORPORATED MEMBERSHIP ROSTER COVER SHEET 2012 CHAPTER NAME: ______
CHAPTER MAILING ADDRESS: ______
CITY ______STATE ______ZIP ______
TELEPHONE NUMBER ( ) ______TAX ID NUMBER______
Financial Secretary______E-mail Address ______Treasurer ______E-mail Address ______
FINANCIAL INFORMATION No. of Members Total ACTIVE MEMBER ______@$50 $______
LIFE MEMBERSHIP ______
NEW LIFE MEMBERSHIP Maroon and White Member ______@$500 $______
Silver Member ______@$1,000 $______
Gold Member ______@$5,000 $______
ASSOCIATE MEMBER ______@$20 $______
CORPORATE MEMBERSHIP Maroon and White ______@$300 $______
Diamond ______@$500 $______
Executive Diamond ______@$1,000 $______
MEMBERSHIP TOTALS ______$______
CHAPTER TAX ($25.00 minimum per year) $______
CHARTER FEE ($50.00 new chapter fee) if applicable $______
CONTRIBUTIONS: 1875 Normalite Campaign ($1000 minimum per chapter) $______Legislative Reception ($250 minimum per chapter) $______
TOTAL THIS REPORT $______Page 2 Membership Roster Cover Sheet
Please list the names of known deceased Normalites (January 2011-December 2011).
Name Provide Dates /Class Year If Known
1. ______
2. ______
3. ______
4. ______
______Chapter President Signature
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address ALABAMA A&M UNIVERSITY ALUMNI ASSOCIATION, INCORPORATED
CHAPTER ANNUAL REPORT 2012
NAME OF CHAPTER ______
OFFICERS
PRESIDENT ______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year
VICE PRESIDENT ______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year Page 2 – CHAPTER ANNUAL REPORT
RECORDING SECRETARY______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year
FINANCIAL SECRETARY______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year Page 3 – CHAPTER ANNUAL REPORT
TREASURER ______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year
PARLIAMENTARIAN ______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year Page 4 – CHAPTER ANNUAL REPORT
HIISTORIAN______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year
CHAPLAIN ______Name
______Mailing Address
______City State Zip Code
______Telephone Number
______E-mail Address Class Year
NAMES AND CATEGORY OF NEW MEMBERS:
1.______CATEGORY______
2.______CATEGORY______
3.______CATEGORY______Page 5 – CHAPTER ANNUAL REPORT
PLEASE INDICATE NUMBER OF MEMBERS IN THE FOLLOWING CATEGORIES
NEW MEMBERS ______
LIFE MEMBERS ______
ACTIVE ______
ASSOCIATE ______
HONORARY ______
DATE(S) OF REGULAR MEETING(S)
______
______
SCHOLARSHIPS TOTAL AMOUNT OF SCHOLARSHIP FUND ______NUMBER OF SCHOLARSHIPS AWARDED ______TOTAL AMOUNT AWARDED ______
CONTRIBUTIONS TO ALABAMA A&M UNIVERSITY (BE SPECIFIC)
1.______
2.______
3.______
4.______
5.______
6.______
7.______Page 6 – CHAPTER ANNUAL REPORT
SIGNIFICANT ACTIVITIES (BE SPECIFIC)
1.______
2.______
3.______
4.______
5.______
6.______
7.______
PROBLEMS/CONCERNS
______
______
Report Submitted By
______Name/Signature
______Office
______Date ALABAMA A&M UNIVERSITY ALUMNI ASSOCIATION, INCORPORATED
CHAPTER FINANCIAL STATEMENT YEAR ENDING DECEMBER 31, 2011
Name of Chapter ______
Submitted by: President ______Signature
Treasurer______Signature Date Approved by Chapter: ______Cash Balance: January 1, 2011 $______Cash Receipts for the Year: $______Membership Dues $______National ______Local ______Life Membership Maroon ______Silver ______Gold ______Income from Events $______Raffle $______Special Fundraising Events (please list) $______
Interest Income $______Other Receipts $______Total Receipts $______Cash Disbursements for the Year: General Operation Fund $______Cost of Fundraising Events $______Postage, Printing, and Supplies $______Normalite Legal Defense Fund $______Contribution to Alabama A&M University $ ______Chapter Tax (By-law change 9/04 - $ 25.00 minimum) Charter Fee ($50.00) $ ______1875 Normalite Campaign $______(By-law change 9/04 -$ 1, 000.00 minimum) Legislative Reception (By-law change 9/04 - $ 250.00 minimum) $ ______Scholarship $______Other Costs $______
Total Disbursements $______
Cash Balance: December 31, 200___ $______Stocks, CD’s, Other Holdings $______
Total Assets $______NATIONAL MEMBERSHIP ROSTER Alabama Agricultural and Mechanical University Alumni Association, Incorporated
______Chapter Name
LIFE MEMBERS
Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______NATIONAL MEMBERSHIP ROSTER Alabama Agricultural and Mechanical University Alumni Association, Incorporated
______Chapter Name
ACTIVE MEMBERS ($50)
Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Major ______Class Year ______
NATIONAL MEMBERSHIP ROSTER Alabama Agricultural and Mechanical University Alumni Association, Incorporated
______Chapter Name
ASSOCIATE MEMBERS ($20)
Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______Name ______Address ______City/State/Zip ______Home Phone ______Cell Phone ______Email Address ______