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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
“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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Villanova, PA 19380
