NEBLSA Membership Boxes

NEBLSA Membership Boxes

Thank you for your interest in the membership boxes and your commitment to strengthening NEBLSA. This form is designed for chapter leaders to request a NEBLSA Membership Box to support recruitment and engagement efforts on their campuses. Please complete all sections to ensure timely processing and delivery of your box, which will be used exclusively to promote NEBLSA membership growth.
Chapter Name
School/Institution
Sub-Region
Primary Contact Person
Full Name
Position (e.g., Chapter President, Membership Chair, etc.)
Email Address
Phone Number
Format: (000) 000-0000.
Mailing Address (include line for suite/office, if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Membership Goals
How many members does your chapter aim to secure this fall?
Do you plan to charge local dues in addition to NBLSA/NEBLSA dues? (Yes/No)
Box Usage
Where do you intend to use the membership box? (tabling, orientation, community event, etc.)
Estimated date(s) of first tabling/membership event
Acknowledgments
By submitting this form, I acknowledge and agree to the following:

1. The membership box will be used strictly for NEBLSA membership growth and related initiatives.

2. I will provide at least one photo or social media tag highlighting the membership table or event where the box is utilized.
Should be Empty: