Membership Application
Fall 2015 – Spring 2016
Check One: Beginning Membership ______ Membership Renewal _______
Name: ______________________________________ Date: ____________
Street Address: _________________________________________________
City: _______________________________ State: _____ Zip: ____________
Phone: (_____)_________________Email: ___________________________
Membership Levels - Check One:
___ $200.00, Patron of the CHSSJ ___ $100.00, Benefactor of the CHSSJ
___ $50.00, Sustaining Member - “Fellow” ___ $12.00, Regular Member
___ $6.00, Student Member (Non-Stockton student). Must include copy of
student ID with this form.
Please pay dues by October 5, 2015
Do you require a receipt for membership to be sent? (circle one): Email USPS
Please make checks payable to “Stockton College Foundation” (with “CHSSJ” in the memo line) and return this form to:
Prof. Amy Papalexandrou, CHSSJ President
School of Arts and Humanities
Stockton University
101 Vera King Farris Drive
Galloway, New Jersey 08205