Friends Membership Application - New Martinsville Campus

Address: (Required)		City: (Required)
County: (Required)	State: (Required)	ZIP: (Required)

Organization/Business Name and Address (if appropriate):
Phone:
Contact Preference:

E-mail: (Required)
Level of Membership: (Required)
Individual, Annual - $15
Individual, Lifetime - $100
Family, Annual - $25
Family, Lifetime - $150
Organization/Business - $75
Please mail your check to:
Friends of the College WV Northern Community College 141 Main Street New Martinsville, WV 26155

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Phone:	Contact Preference:
E-mail: (Required)

Campuses