Membership Application

Name: Title:

Organization:

Address:

City/State/Zip: Email:

Phone: Fax:

Please indicate level of membership and fee:

Individual (Not associated with a business, school or agency) $50.00 ___

Organization (Based on total number of employees)

1 – 25 $100.00 ___

26 – 75 $250.00 ___

76 – 150 $400.00 ___

151 – 300 $700.00 ___

301 – 500 $1500.00 ___

Over 500 $2500.00 ___

Optional contributions in addition to annual membership fees:

Sustaining Membership $5000.00 ___

Supporting Membership $2000.00 ___

Contributing Membership $500.00 ___

By submitting this application, I hereby apply for membership in the Alaska Business Education Compact. I am aware that my membership is for the calendar year 2001.

Signature: Date:

Please print, attach check or purchase order made out to Alaska Business Education Compact and mail to: Alaska Business Education Compact

P.O. Box 240546

Anchorage, Alaska  99524-0546

Thank you for supporting the Alaska Business Education Compact!