New Members 2025 NCCU Raleigh-Wake Membership Form

Membership Form

NCCU Raleigh-Wake Membership Form
Please note that none of this information will be shared with anyone outside of the chapter for solicitation purposes.
For which calendar year should this payment be credited?*
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Please include me in the chapter's private address book.*
Are you currently a business owner? Our chapter will be creating a business directory*

Do you have an emergency contact that you would like to provide in the case of an emergency during a chapter event?
If you answered yes to the above question, please complete the contact information below.

First NameLast Name
Please enter a valid phone number.

Date of Birth*

MonthDayYear
Date
Date of Graduation*

MonthDayYear
Date
Major*
Date of Graduation (second degree)

MonthDayYear
Date
Major (second degree)
I authorize the North Carolina Central University Raleigh-Wake Alumni Chapter to utilize my image from events that I may attend on the Chapter's Website.*

I opt inI opt out

Are you interested in any of the following sub-committees? (select only two)

SocialScholarshipMembershipProgramAuditAmenities
I am currently a Lifetime Member of the North Carolina National Alumni Association.*

YesNo
If you were referred by someone, please provide their name below.

If something should happen to you, would you like for the chapter to send a resolution?*

YesNo
If you selected yes above, please provide the contact information for the person whom we should contact.

First NameLast Name
Phone Number
Please enter a valid phone number.

Please note that by paying your National Dues via the chapter, we will forward your payment over to the National Alumni Association in your name within 30 days.

Membership runs from July 1st - June 30th
My Products*
prevnext( X )
New MembershipI am a new member joining the NCCU Raleigh-Wake Alumni Chapter.
$45.00



Honorary Member You might not have graduated from NCCU but you would love to be a part of the nest, this is the membership for you!
$45.00



Eagle TeamNCCU Raleigh-Wake Alumni Chapters Annual Giving Program. $100 Pledge/100% Participation
$100.00



CashApp/Mail-in PaymentSelect this option if you will be mailing in your payment or submitting it via CashApp ($NCCURaleighWake or PO Box 1331 Raleigh, NC 27602 -1331)
$ Free



Recent Under GraduatesAll recent under graduates are given a year of Free Dues from the Raleigh-Wake Alumni Chapter. This is granted based on your gradutaion date above.
$ Free



Total

$0.00
Should be Empty:

Membership Form