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MM4E Membership Application

Indicates required information

Category of Membership

New Renewal

First Name:

Middle Name:

Last Name:

Date of Birth:

Student ID#:

G.P.A.:

Class Level:

Expected Graduation:

Status (check one):

First time in College Returning Student

Semester & Year:

Major/Concentration:

Minor (if applicable):

Contact Information

Mailing Address:

Email:

Home Phone:

Mobile Phone:

How did you learn about MM4E?

Are you interested in becoming actively involved? (please check one)

Yes, I would like to become actively involved, and have time to devote.

Yes, I would like to become actively involved, but have limited time to devote.

No, I do not wish to be actively involved, but do wish to take advantage of MM4E membership benefits.

If you would like to be actively involved and have time to devote, would you like to hold a leadership position? (check one):

Yes No