NATIONAL
ASSOCIATION
OF FELLOWSHIPS ADVISORS
INSTITUTIONAL AND INDIVIDUAL MEMBERSHIP FORM
To become a member of the National Association of Fellowships Advisors, complete this form and mail it with your payment to John Richardson, NAFA Treasurer, Honors Program, University of Louisville, Louisville, Kentucky 40292. Make checks payable to NAFA.
INSTITUTIONAL MEMBERSHIPS CAN
INCLUDE UP TO THREE INDIVIDUALS.
Dr./
Mr./ Ms.
_________________________________________________________________
Title ________________________________________________________________________
Home Address
________________________________________________________________
State_________________ Zip ________________ Home Phone (______) ______________
Work Phone (______) ______________ Fax
(______) ______________
University/College
_____________________________________________________________
Address
______________________________________________________________________
City
_________________________ State
__________________ Zip
____________________
E-mail Address
_______________________________________________________________
Please add me to the NAFA
listserv. I
am already on the NAFA listserv.
I do not wish to be included on the NAFA listserv.
Amount Enclosed: 
$150 for individual
membership
$200 for institutional
membership
If you are applying for an institutional membership, please list the other individuals to be included and attach the second page of this form with complete information for each of these members.
________________________________________
________________________________________
Form of Payment: Check
or money order enclosed
Completed purchase order
enclosed
Credit Card: Visa ____ Master Card ____
Number ___________ญญ____________________ Exp. Date
___________
Signature
____________________________________________________
SECOND INSTITUTIONAL MEMBER
Dr./
Mr./ Ms. _________________________________________________________________
Title
________________________________________________________________________
Work Phone (______)
______________ Fax (______)
______________
University/College _____________________________________________________________
Address
______________________________________________________________________
City
________________________ State
___________________ Zip
____________________
E-mail Address _______________________________________________________________
Please add me to the NAFA
listserv. I
am already on the NAFA listserv.
I do not wish to be included on the NAFA listserv.
THIRD INSTITUTIONAL MEMBER
Dr./
Mr./ Ms.
_________________________________________________________________
Title
________________________________________________________________________
Work Phone (______)
______________ Fax (______)
______________
University/College
_____________________________________________________________
Address ______________________________________________________________________
City
________________________ State
___________________ Zip
____________________
E-mail Address
_______________________________________________________________
Please add me to the NAFA
listserv. I
am already on the NAFA listserv.
I do not wish to be included on the NAFA listserv.