NATIONAL
ASSOCIATION
OF FELLOWSHIPS ADVISORS
INSTITUTIONAL AND INDIVIDUAL MEMBERSHIP FORM
To become a member of the National Association of Fellowships Advisors, complete this form and mail it with your payment to John Richardson, NAFA Treasurer, Honors Program, University of Louisville, Louisville, Kentucky 40292. Make checks payable to the NAFA. Federal ID#61-1014882 INSTITUTIONAL MEMBERSHIPS CAN INCLUDE UP TO THREE INDIVIDUALS.
Dr./
Mr./ Ms. _________________________________________________________________
Title
________________________________________________________________________
Home Address
________________________________________________________________
State_________________ Zip ________________ Home Phone (______) ______________
Work Phone (______) ______________ Fax
(______) ______________
University/College
_____________________________________________________________
Address
______________________________________________________________________
City
_________________________ State
__________________ Zip
____________________
E-mail Address
_______________________________________________________________
”
Please add me to the NAFA
listserv. ”
I am already on the NAFA
listserv.
”
I do not wish to be included
on the NAFA listserv.
Amount Enclosed: ”
$150 for individual
membership
”
$200 for institutional
membership
If you are applying for an institutional membership, please list the other individuals to be included and attach the second page of this form with complete information for each of these members.
________________________________________
________________________________________
Form of Payment: ” Check
or money order enclosed
”
Completed purchase order
enclosed
”
Credit Card: Visa ____ Master Card ____
Number ___________ญญ_____________ Exp. Date
___________
Signature
_____________________________________________
Please consider me for the following committee
assignments:
”
Programming and Conventions ”
Organization Issues (rules,
records)
”
Materials and Media
(newsletters, brochures, public relations) ”
Ethics
” Foundation Relations ”
Finance
”
Student/Faculty Issues ”
Other _______________________
NATIONAL
ASSOCIATION
OF FELLOWSHIPS ADVISORS
SECOND INSTITUTIONAL MEMBER
Dr./
Mr./ Ms.
_________________________________________________________________
Title ________________________________________________________________________
Work Phone (______)
______________ Fax (______)
______________
University/College
_____________________________________________________________
Address ______________________________________________________________________
City
________________________ State
___________________ Zip
____________________
E-mail Address
_______________________________________________________________
”
Please add me to the NAFA
listserv. ”
I am already on the NAFA
listserv.
”
I do not wish to be included
on the NAFA listserv.
Please consider me for the following committee
assignments:
”
Programming and Conventions ”
Organization Issues (rules, records)
”
Materials and Media
(newsletters, brochures, public relations) ”
Ethics
” Foundation Relations ”
Finance
”
Student/Faculty
Issues ”
Other _______________________
THIRD INSTITUTIONAL MEMBER
Dr./
Mr./ Ms. _________________________________________________________________
Title
________________________________________________________________________
Work Phone (______)
______________ Fax (______)
______________
University/College _____________________________________________________________
Address
______________________________________________________________________
City
________________________ State
___________________ Zip
____________________
E-mail Address _______________________________________________________________
”
Please add me to the NAFA
listserv. ”
I am already on the NAFA
listserv.
”
I do not wish to be included
on the NAFA listserv.
Please consider me for the following committee
assignments:
”
Programming and Conventions ”
Organization Issues (rules,
records)
”
Materials and Media
(newsletters, brochures, public relations) ”
Ethics
” Foundation Relations ”
Finance
”
Student/Faculty
Issues ”
Other ________________________