Membership Enrollment Form
 
Click here to download a printable Member Enrollment form
 

    

    

   

   

   

   

MEMBERSHIP ENROLLMENT FORM

July 1, 2013 – June 30, 2014

Name of Institution: _______________________________________________

 

Department URL: _________________________________________________

 

Address: _________________________________________________________

 

City: _______________________________  State: ______   Zip: ____________

 

Contact Person: ___________________________________________________

                                    

Title: ____________________________________________________________

 

Office: __________________________________________________________

 

Telephone Number: ____________________ Fax: ____________________

 

Email Address: __________________________________________________

(Please list other member participants [no limit] and their contact information on the reverse).

Membership Fee:  $125

Please submit via U.S. mail with your membership fee to:

Joan M. O’Brien

Office of Planning and Institutional Research (OPIR)

Villanova University, 800 Lancaster Avenue, Villanova, PA 19085-1699

Phone: 610-519-4558                                   e-mail: joan.obrien@villanova.edu

 

Text Box: Checks payable to:  Villanova University – CHERC
 

 

 “If there are additional individuals from your institution who would like to be on the CHERC list of member participants, please list them and their contact information on the back of this sheet. 
There are no additional fees for added member participants.”
 

 

     
 
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