Click the Link Below to Download the Form
Talladega College National Alumni Association, Inc.
2008 Membership Dues
(January 1, 2008 - December 31, 2008)
Title First Name Middle Maiden (if applicable) Last Name
___________________________________________________________________________
Address
__________________________________________________________________________
City/State/Zip
___________________________________________________________________________
Home Phone ____________ Business/Office Phone_____________
Fax__________________ e-mail ___________________
Today's Date _________________________
Please Check (X) one:
Graduate: Class of_____________
Former Student: List with Class of_______
Friend / Supporter____________
Geographical Location: Please check (X) one:
___Midwestern Region: Iowa, Illinois, Indiana, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, West Virginia,
Wisconsin.
___Eastern Region: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire,
New Jersey, New York, Pennsylvania, Rhode Island,
Vermont, Virginia, Bermuda.
___ Southern Region: Alabama, Arkansas, Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee.
___ Far Western Region: California, Idaho, Montana, Nevada, North Dakota,Oregon, South Dakota, Utah, Washington. Wyoming,
Hawaii, Alaska.
___ Southwestern Region: Arizona, Colorado, Louisiana, New Mexico, Oklahoma, Texas
Make $50.00 Check / Money Order for Dues Payable to:
Talladega College National Alumni Association, Inc.
Mail to: Leonard Smith
National Financial Secretary
15566 Signal Hill Court
Granger, Indiana 46530
