Enclosed is my payment of $ for:

$50 Annual Membership

$700 Life Membership

Payment toward a Life Membership
($140 per year for 5 years - minimum payment $70)

Other (Specify)

$5 Donation for an Association Lapel Pin (Members Only)

Student Type: Cadet CGC Both Non-Alumni/Associate Member

Full Name as Student:
(NO NICKNAMES!)
Year Graduated: (First Degree)

Street 1:
Street 2:
City: State: Zip Code:
Phone:
Email Address:

Payment Type:

American Express MasterCard Visa Personal Check

Card #: Exp:

Credit Card Billing Address (If Different From Above)
Street:
City/State/Zip: