West Point Society Of Philadelphia Membership Application 2010

The West Point Society of Philadelphia Attn: Bill Belknap „81 845 Tremont Drive

Downingtown, PA 19335

ANNUAL DIRECTORY AND REGISTRATION FORM 1 SEPTEMBER 2009 – 31 AUGUST 2010 Please use this form to remit your annual dues and to advise the Society of changes in your listing information. Society Members and many other local area graduates will be listed in the directory. However, dues must be paid in order to receive the Directory and other mailings. Send dues/application to Bill Belknap at the above address. PLEASE MAKE CHECKS PAYABLE TO “THE WEST POINT SOCIETY OF PHILADELPHIA”. NOTE: MEMBERSHIP DUES ARE TAX DEDUCTIBLE – 501(c)7 ORGANIZATION. MEMBERSHIP:

REGULAR LIFE

$40.00

CURRENT STATUS:

CIVILIAN

$500.00

Check one

PLEASE COMPLETE THIS SECTION: USMA CLASS: ________ LAST NAME: _____________________ FIRST NAME: _____________ M.I.: __________ ASSOC.: _________ CHECK HERE IF NO CHANGES FROM LAST DIRECTORY:  HOME ADDRESS: ______________________________________________________________________ CITY: __________________________ STATE: ______ ZIP+4: ________+_______ HOME PHONE: ( ) _____________ SPOUSE‟S FIRST NAME: _______________________________ E-MAIL ADDRESS: _____________________________________________________________________ HIGHEST MILITARY RANK HELD: ______________ BRANCH: _________ SERVICE: ______________________ FOR THOSE IN CIVILIAN ENDEAVORS: BUSINESS TITLE: _______________________ COMPANY NAME: ___________________________ _____________________________________ BUSINESS ADDRESS: ________________________________________________________________________ CITY: __________________________ STATE: ______ ZIP+4: ________+_______ BUSINESS PHONE: ( ) ________________ EXT.: _______ FAX NO.: ( ) ____________________ BUSINESS E-MAIL ADDRESS: ____________________________________________________________ TYPE OF BUSINESS: (Use one of the categories below, if other, describe business): _______________________ Accounting Aerospace Airlines Architecture Associations Automotive Aviation Banking Chemicals Communications

Computer Sciences Construction Consulting Contracting Counseling Distribution Education Electronics Engineering Environmental

Farming Financial Services Foundations Government Health Services Hotels/Restaurants Information Systems Insurance International Services Journalism

Law/Legal Maintenance/Repair Manufacturing Marketing Medicine Military Service Oil and Gas Oil Field Services Operations/Maintenance Placement Services

Printing/Publishing Property Management Public/Private Utility Real Estate Recreation Research Security Telecommunications Transportation Travel Waste Mgmt

I am interested in assisting with the following activities (CIRCLE ONE OR MORE): Army/Navy Dinner Dance Founders‟ Day Dinner USMA Recruiting

Membership Advertising Luncheons

Career Advisory Committee Programs Speakers

Networking Patriot League AOG Activism

Directory Assembly Articles Newsletter

SIGNATURE: ________________________________________ DATE: ____________________________ ASSOCIATES: MUST have 2 Graduates sign off for recommendation _________________________________________