COUNCIL INFORMATION: Check if you would like all correspondence to go to the campus advisor Name: Graduate Undergraduate (Example: NPHC of Howard University or NPHC of Dallas) Address: City: State: Zip Code: Tele: Fax: Email: Council Website: OFFICER INFORMATION: President: Tele: h/c w Email: Treasurer: Tele: h/c w Email: DEMOGRAPHICS: List the names of each financially active chapters in your council (Attached additional page, if necessary) Chapter should be referenced by Member Organization-Chapter Name (e.g. Lambda) -Delta COUNCIL ADVISORS: if applicable Campus Tele: h/c w Advisor: Email: Alumni Tele: h/c w Council Advisor: Email: Qty Item Cost Notes Undergraduate Council Dues $150.00 Alumni/Graduate Council Dues Alumni/Graduate Council dues are determined by the number of chapters affiliated 1-9 Chapters = $250 with the Council. 10-19 Chapters = $300 20-29 Chapters = $350 30+ Chapters = $450 Late Fee $25.00 MUST add to dues if postmarked after February 15 Reactivation Fee $50.00 Pertains to councils not financial in previous fiscal year; in addition, dues for previous and current FY must be remitted Charter Fee $100.00 Please include appropriate council dues Replacement Charter $20.00 Note: Charters prior to 1994 may not be available Lapel Pin $15.00 NPHC Badge 1- $10 2-$15 Payment Type (check): MO Check Online Total $ Remitter: Date:
COUNCIL INFORMATION: Check if you would like all correspondence to go to the campus advisor Name: Graduate Undergraduate (Example: NPHC of Howard University or NPHC of Dallas) Address: City: State: Zip Code: Tele: Fax: Email: Council Website: OFFICER INFORMATION: President: Tele: h/c w Email: Treasurer: Tele: h/c w Email: DEMOGRAPHICS: List the names of each financially active chapters in your council (Attached additional page, if necessary) Chapter should be referenced by Member Organization-Chapter Name (e.g. -Delta Lambda) COUNCIL ADVISORS: if applicable Campus Advisor: Tele: h/c w Email: Alumni Council Advisor: Tele: h/c w Email: Qty Item Cost Notes Undergraduate Council Dues $150.00 Alumni/Graduate Council Dues 1-9 Chapters = $250 10-19 Chapters = $300 20-29 Chapters = $350 30+ Chapters = $450 Alumni/Graduate Council dues are determined by the number of chapters affiliated with the Council. Late Fee $25.00 MUST add to dues if postmarked after February 15 Reactivation Fee $50.00 Pertains to councils not financial in previous fiscal year; in addition, dues for previous and current FY must be remitted Charter Fee $100.00 Please include appropriate council dues Replacement Charter $20.00 Note: Charters prior to 1994 may not be available Lapel Pin $15.00 NPHC Badge 1- $10 2-$15 Total $ Payment Type (check): MO Check Online Remitter: Date: