North East Affiliate of College and University Residence Halls Antler Society Application The Antler Society is the name of the NEACURH Alumni Society: students, advisors, and other individuals who have been involved in the NEACURH organization and contributed to it's growth and development. Applications may be submitted by an individual, or on behalf of an individual. For a small, one time fee of $10.00, inductees will receive an Antler Society pin, induction certificate, and monthly newsletters. Inductees will also be added to the NEACURH Antler Society Alumni Page on the NEACURH Website. All proceeds from Society inductions help fund the NEACURH Scholarship and Programming Grant. Name:
School: School you attended while involved with NEACURH or company that sponsored NEACURH activities.
Will you be attending the next NEACURH/NACURH Conference?
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No
Permanent Mailing Address:*
Email Address:
Phone Number:*
Would you like your contact information (email only) available on the Website?
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Please answer the following on the back, or a separate sheet of paper. 1. List any leadership involvements in NEACURH/NACURH. 2. List any NEACURH/NACURH conferences or events attended. There is a $10.00 fee for entrance into the Antler Society. Please make check payable to NEACURH and enclose it with this form. No Applications will be processed without payment. Do you need an invoice for your payment?
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No
Invoices will be emailed in pdf format to email address listed above if requested.
This information is factual and can be used on the NEACURH Website as part of my induction to the Antler Society.
Signature of Applicant:
Date:
If you would like to be honored at the 2012 Mini No-Frills Conference at Rhode Island College , please send your application and payment no later than February 26, 2012 to: Mary Gallivan, NEACURH Regional Advisor ∙ 123 Richmond Quadrangle ∙ Buffalo, NY 14261 FOR REGIONAL USE ONLY Received:
This information is factual and can be used on the NEACURH Website as part of my induction to the Antler Society. Signature of Applicant: Date: If you would like ...
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