Membership Form

Brooklyn College Faculty Circle

Membership Form

BROOKLYN COLLEGE FACULTY CIRCLE  Academic Year Annual Membership Form

NAME _____________________________________________________________

BC DEPARTMENT/OFFICE ________________________________________

ADDRESS __________________________________________________________

______________________________________ZIP__________________________

PHONE #s [HOME] _______________________ [OFFICE] x___________

E-MAIL ____________________________________________________________

Membership Dues: *
  RENEWING MEMBERSHIP [ ] NEW FAC. / INST. STAFF (first year free) [ ]   ACTIVE $30.00 [ ] RETIRED/ADJUNCT $15.00 [ ]
  Additional Voluntary Contribution $_______
TOTAL ENCLOSED: $____________

Brooklyn College Faculty Circle welcomes all full and part time faculty/instructional staff, HEOs, CLTs, Administrators and Retirees.

To be a member this year, please fill out this form and mail it with your check (Please make check payable to BC Member Organization, Memo: Faculty Circle) to:

Membership Chairperson
Brooklyn College Faculty Circle Brooklyn College  2900 Bedford Avenue  Brooklyn, NY 11210-2889