Alabama A&M University Alumni Association, Incorporated

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)

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 ______