N.E.R.A. Membership Application Survey

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1. Mailing Address

Mailing Address Name:
Street Address:
City:
State:
Zip Code:

2. Additional Contact Info:

Additional Contact Info: Phone Number:
Email Address:
Birth date:

3. Preferred Method of Contact:

Preferred Method of Contact: Snail Mail

Phone

I would rather not be contacted.

4. Current Academic Info:

Current Academic Info: Current School Attending:
Chapter Name:
Officer Positions Held:
Graduation Date:
Transfer College:

5. Would you like to contibute your talents to the growth of the organization and/or with regional events?

Would you like to contibute your talents to the growth of the organization and/or with regional events? Yes

6. If yes, what areas would you be most interested in?

If yes, what areas would you be most interested in? Public Relations/Promotions

Technology Assistance

Event Planning

Graphic Design

Event On-Site Assistance

Workshop Presenter

Other (please specify)

7. Are you interested in serving as an officer?

Are you interested in serving as an officer? Yes

Maybe

8. Additional Comments:

Additional Comments:

Please fill out all sections.

If you prefer to pay online, please use the paypal link on the Membership page of www.nera.neptk.org

To pay by check, please make it payable to: N.E.R.A. —New England Region Alumni in the amount of $25 for annual membership or $250 for a lifetime membership and mail it to the address below. If your name is not on your check, please include a note with your name and contact information.

Mail to:
N.E.R.A
C/O Michelle Brinck, Co-Advisor
81 River Street
New Canaan, CT 06840

Thank you.

N.E.R.A. Membership Application
Exit this survey

1. N.E.R.A. Membership Application

*
1. Mailing Address

2. Additional Contact Info:

3. Preferred Method of Contact:

4. Current Academic Info:

5. Would you like to contibute your talents to the growth of the organization and/or with regional events?

6. If yes, what areas would you be most interested in?

7. Are you interested in serving as an officer?

8. Additional Comments:

N.E.R.A. Membership ApplicationExit this survey

1. N.E.R.A. Membership Application

*1. Mailing Address

2. Additional Contact Info:

3. Preferred Method of Contact:

4. Current Academic Info:

5. Would you like to contibute your talents to the growth of the organization and/or with regional events?

6. If yes, what areas would you be most interested in?

7. Are you interested in serving as an officer?

8. Additional Comments:

N.E.R.A. Membership Application
Exit this survey

*
1. Mailing Address