MCHC Membership Form

Membership Form and Dues Notice for 2005

Name: _________________________________________________________________

Title: __________________________________________________________________

Institution: _____________________________________________________________

Address: _______________________________________________________________

Telephone Number: ______________________________ New Member? ________

E-mail address: _________________________________________________________

MEMBERSHIP CATEGORY:

________ Institution: $50.00 *

________ Individual: $15.00

________ Student: $ 5.00

*An institutional membership to MCHC includes five students. Please list the

names of the students on your 2005 membership:

______________________________________________________________________

Please make your check payable to MCHC, and return this form to:

Dr. Maureen P. Connelly, MCHC Treasurer

Frostburg State University

Honors Program Guild Center

Frostburg, MD 21532

Go back to the Maryland Collegiate Honors Council Home Page