2026-2027 Greater Northern VA Chapter (GRNOVA) Norfolk State University Alumni Association Membership Application

Greater Northern VA Chapter (GRNOVA) of Norfolk State University Alumni Association Membership Application

Fiscal Year - July 1, 2026 - June 30, 2027
Is this a New Membership or Renewal?
Type of Membership:
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.Format: (000) 000-0000.
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last Four Digits of your SSN:
Have you ever been affiliated with another Chapter? If 'Yes', Please list the previous Chapter Name.
Did you attend NSU? If 'YES", please provide the Years attended, Major and Degree/Certificate earned.
Graduation Year:
Current Employment Position:
Areas/Committees of Interest: (You may select up to 3 choices)
Dues Payment Options:
1. PayPal - Make a selection below and then submit this form. You will be redirected to PayPal where you will complete your dues payment.
2. Zelle - Submit this form. Afterwards, complete your dues payment via Zelle - greaternovansuaa@gmail.com.
3. Mail - Submit this form. Mail a Check or Money Order, payable to GRNOVA Chapter - P.O Box 90441, Alexandria, VA 22309-9998.
*** Reminder: If you are paying your dues via Zelle or Mail, please submit this form now.

If you are paying your dues via PayPal, please make a selection below then submit this form.
Please select Membership Type (this section is for individuals paying dues via PayPal):
prevnext( X )
Regular/Associate Member
Regular/Associate Dues incl. transaction fee

$105.00 Quantity

Lifetime Member
Lifetime Member Dues incl. transaction fee

$80.00 Quantity

Total

$0.00
Should be Empty:

Greater Northern VA Chapter (GRNOVA) of Norfolk State University Alumni Association Membership Application

Please select Membership Type (this section is for individuals paying dues via PayPal):