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Home » Alumni » Alumni Association Membership Application

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Lincoln University National Alumni Association Membership Application

(Membership period is from January 1 to December 31)

Name (First Middle Last Maiden):
Spouse's Name:
Street Address:
City, State, Zip:
Telephone (Home):
Telephone (Work):
Email Address:
Fax:
Year Graduated:
Degree Earned:
SS#:
Profession/Job Title:
Employer:
Employer Address:

Please check one:

Individual Membership..........$40.00 per year	Associate Membership..........$40.00 per year (Not a graduate, but has a genuine interest in the promotion of the Association/University)
Golden Life Membership..........$500.00 62 years of age & beyond (To be paid in full or over a four (4) year period of $100.00 per yr.)	Silver Life Membership..........$1000.00 61 years of age or younger (To be paid in full or over a four (4) year period of $250.00 per yr.)

*Local chapter dues are in addition to the national dues*

Chapter Name (if applicable):
National membership payment:	$
Subscribing Life membership payment:	$
Local Chapter membership payment:	$
Enclosed total payment:	$
Select Credit Card Type::
Card Number::
Exp. Date::

Make your check/money order payable to
Lincoln University Alumni Association

Send Checks or money orders to:

Lincoln University
Office of Alumni Affairs
818 Chestnut St., Memorial Hall
Jefferson City, MO 65102-0029
573-681-5573 or 5572
Fax: (573) 681-5892
griffins@lincolnu.edu or
williamb@lincolnu.edu