Member Application and Data Form
Name: First ________________ Middle ______ Last ________________ Suffix _______
Salutation: ________________ Nickname:
Organization: ______________________ Business Title: ________________ Profession*: ______ Industry*: _______
Work Address: ___________________________________ Work Phone: ________________ Wk Ext.: ____
City ________________ State ____ Zip Code ________________
Home Address: ___________________________________ Home Phone: ________________
City ________________ State ____ Zip Code ________________
Military Rank: ________________ USMA Class: ________ Email Address: ______________________________
Mail Preference? Home or Office (circle one) Spouse Name: _____________ Spouse a Grad? If so, Class Year:________
Graduate School: ___________________________________ Graduate School Year: ________
Graduate Degree: ___________________________________
Sports Interest*? (Golf, Football, Baseball, Soccer, Hockey, Other) : __________________
PARTICIPATION INTEREST:
I would like to serve:
as a Board Member: ____
on an Activity Committee: ____
on a Founders Day Committee: ____
on a Career Advisory Committee: ____
as a Speaker Coordinator: ____
as a Class Point of Contact: ____
as a MALO: ____
in another capacity (describe): ____
PAYMENT:
Please make your dues
(and any contributions) payable by check to the West Point Society of
the San Francisco Bay Area. Contributions are not tax
deductible.
Annual Dues:
$35.00
Dues Paid Date: ___________
Dues Amount: $ ___________
Contribution: $ ___________
Total:
$ ___________
Please complete this
form and send it with your check to:
West Point Society
SFBA (c/o Nina Leslie)
5410 Fernhoff Road
Oakland, CA 94619