MEMBERSHIP FORM

 

Name ________________________________ Class _____

Spouse _______________________________ Class _____

Address _________________________________________

City ______________________State _________ Zip _____

Phone Number ___________________________________

Email Address ____________________________________

Work Information __________________________________

Work Address ____________________________________

Work Phone Number _______________________________

 

Individual - $40 Family - $60

 

New Member _____

 

Additional contribution to the Southeast Texas A&M Foundation ______

 

I am interested in being a meeting Sponsor for the month of _______ at the following level:

____Gold - $150 or more

____Silver - $100 to $149

____ Bronze - up to $99

 

Please make check payable to: Southeast Texas A&M Foundation

 

Mail to: Southeast Texas A&M Foundation

P. O. Box 22902

            Beaumont, TX 77720-2902