ND Club of Orange County Sign-Up Form
Please be sure to fill out all information marked with an asterisk. Once completed, click the Continue button at the bottom of this page to verify the information and select a payment option if you owe any payment. You will have the option to print the page and mail it in or pay online using a VeriSign Secure Page. Thanks for your support!
1) Name and Email Address
Title Dr. Dr. & Mrs. Fr. Hon. Most Rev Mr. Mr. & Mrs. Mrs. Ms. Rev. Rev. Msgr. Sr. Very Rev *First and Middle Initial *Last Suffix CSC D.D.S. II III Jr. M.D. PhD Sr.
Email Address (if you have one): Please do NOT send me Club news via email. Please do NOT include me in the Online Member Directory.
2) *Address and Phone Numbers	3) Work Information
*Address Line 1: Home Work Address Line 2: *City, *State, *Zip:   AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY	Company: Student Retired Job Title: I would like to be included in the local employment network.
Home Phone:	Work Phone:
4) Affiliation to Notre Dame	5) Interested in Getting Involved
ND Student/Alum Grad Yr: Major: Degree: ARCH BA BBA BFA BS EG JD MA MBA MS PhD Grad Yr: Major: Degree: ARCH BA BBA BFA BS EG JD MA MBA MS PhD SMC Student/Alum Grad Yr: Major: Degree: ARCH BA BBA BFA BS EG JD MA MBA MS PhD Grad Yr: Major: Degree: ARCH BA BBA BFA BS EG JD MA MBA MS PhD Parent of ND Student/Alum Parent of SMC Student/Alum Friend of the University	General Volunteer ND Club Board of Directors Housing ND Students in Town for Summer Service Projects or Other Student Events Corporate Sponsorship of Club Events Community Service Young Alumni Events Senior Alumni Volunteers (55+ yrs old) ND Club Annual Golf Tournament Networking Events
6) ND Club Membership
If you are already a member, please select "Current Dues Already Paid". Otherwise, if you would like to pay membership dues as part of this transaction (it is not required), select a membership level below. Membership Type (Cost) Amount Due Current Dues Already Paid 2008 Irish Green Membership ($30.00) 2008 ND Blue Membership ($60.00) 2008 Golden Dome Membership ($120.00) Please check this box if you were not a dues-paying member last year and would like to be eligible to purchase ND Football tickets from the Club this year. You will be assessed the $30.00 New Member Fee.
7) ND Club Scholarship Fund
If you would like to make a contribution to the ND Club of Orange County Scholarship Fund to help local OC students with the burdens of loans and tuition, please enter the amount you would like to contribute to the right. Amount Due
8) Verify Total Amount Due
Total
9) Additional Comments