Northeast Mississippi
Community College

 
FOUNDATION MEMBERSHIP APPLICATION

 

by calling
(662) 720-7185
using

Please type your information into the following application. Once you have typed in all of you information, print this page and mail it along with your check to the following address.

Northeast Development Foundation
D. Patrick Eaton, Executive Director
101 Cunningham Blvd.
Booneville, MS 38829

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Work Phone
FAX
E-mail
URL
Address

Choose any of the following membership levels that apply:

VIP Business/Corporation (Any Size) - $2000 or more
VIP Non-Profit Organization - $1500 or more
VIP Individual - $1000 or more
Business/Corporation (50 Employees or More) - $500
Business/Corporation (Less than 50 Employees) - $250
Non-Profit Organization- $100
Go-Tiger Individual - $500
Individual - $50

Please indicated the exact amount of your contribution.
$

Are you an alumni of NEMCC?

Yes No

If you answered yes to the previous question, enter the year(s) you attended NEMCC in the space provided below.

Enter today's date in the blank provided :

Thank you for joining the
Northeast Development Foundation.

For more information about the Northeast Development Foundation, please call Patrick Eaton at (662) 720-7165 or e-mail us at peaton@northeast.ms.