Individual Membership Form

General Information

Name *

Occupation *

Name of School *

Address *

City *

State *

Zip Code *

E-mail *

Telephone *

Web Site

Membership Status * New membership
Membership renewal

Membership Type Full membership (1 year)

My Information Do not include my information on the NCSC web site

Membership Affiliation Statement

I, ________________________, recognizing my identity in the Christian faith as confessed by the Roman Catholic Church, and living in creative and dynamic relationships with my church, at this time do hereby affiliate with the National Catholic Student Coalition for the academic year 2011-2012.

I understand that by clicking "Submit," I am signing, either for myself or as a representative of a campus ministry, in the affirmative for the statement above as it applies appropriately. I also assert that all of the above information is true and that I have the authority to affiliate myself/my organization with the National Catholic Student Coalition.

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