VIRGINIAs COLLEGIATE HONORS COUNCIL

Annual Dues Form

Calendar Year 2009

Mail to:

Ms. Gwendolyn Epps Pharr

ATTN: VCHC

Norfolk State University

P.O. Box 2890

700 Park Ave.

Norfolk, Virginia 23504

For additional information please call Gwen at 757.823.2267 or email gepharr@nsu.edu with questions.

Checks should be made payable to VCHC.  (Federal Tax ID# 54-1345506)

Institutional               [   ]    $35.00

Individual (faculty)    [  ]    $10.00 each  

Name email

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Individual (students) [   ]    $10.00 each  

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Total enclosed:

College/University:

Address:

Honors Program Director/Contact Person:

Position:

Email: Tel: Fax:

This form is also available at http://www.longwood.edu/vchc/