<p> Membership Summary Sheet and Payment Form</p><p>Alumni Chapter Name: Affiliate Number: </p><p>Alumni Chapter Address:</p><p>Alumni Chapter Contact Person: </p><p>Total Number of members paying ______at $3.00 per member. $______Total Amount Annual State dues: for Annual State Dues</p><p>Total Number of members paying ______at $10.00 per member. $______Total Amount Annual National dues: for Annual National Dues</p><p>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**</p><p>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**</p><p>Total Number of Subscriptions to ______at $2.00 per annual $______Total Amount FFA New Horizons member. for New Horizons Subscriptions</p><p>Grand Total Membership and Magazine $______Subscriptions</p><p>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</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>6.</p><p>7.</p><p>8.</p><p>9.</p><p>10.</p><p>NATIONAL LIFE MEMBERSHIP Please list names of those paying National Life Dues</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>6.</p><p>7.</p><p>8.</p><p>9.</p><p>10. Alumni Chapter Leadership Form</p><p>Alumni Chapter Name: Affiliate Number: </p><p>Alumni Chapter Address:</p><p>Alumni Chapter Contact Person:</p><p>Please list your FFA Alumni chapter officers </p><p>______, President</p><p>______, Vice President</p><p>______, Secretary</p><p>______, Treasurer</p><p>______, Council Member</p><p>______, Council Member</p><p>______, Council Member</p><p>______, Council Member</p><p>______, Council Member</p><p>______, Other Officer ______</p><p>______, Other Officer ______</p><p>______, Other Officer ______</p><p>When does the term of service expire for these officers? ______Date</p>