An association of alumni of New York University Stern School of Business
P.O. Box 3912 | New York, NY 10163
WWW.THE-EXECUTIVEFORUM-NYU.ORG E-MAIL OF EVENT COORDINATOR: cfeinstein.executiveforum@gmail.com

MEMBERSHIP APPLICATION 2009 - 2010
DINNER/SPEAKER SERIES

Please return this membership application to the above address, and enclose a check payable to The Executive Forum as follows:

Annual membership dues and the series of five dinners (1)......................................$275.00
Voluntary, tax-deductible contribution to our Stern Scholarship Program (1) …...________
Guest fee for October 28 dinner only (2) .................................................................______
Total amount of payment………………………...........................................................$______

To pay on line click on button

Include information as you wish it to appear in future issues of the MEMBERSHIP DIRECTORY. If, during the year, you move or change companies, please remember to notify the Events Coordinator so that your most up-to-date information appears in our directory.

        Please check which address to use for e-mail or postal mail - Business / Home
          Name: ____________________________________________________________
          Title: __________________________________________________
         Company: _________________________________________
         Address:   _________________________________________
           _________________________________________
           E-mail-Address__________________Telephone # ____________________
         Fax #___________________
          Home Address: ____________________________________________________________
          ____________________________________________________________
        E-mail-Address_______________________   Telephone # ____________________
        Fax #__________________
          If referred by an Executive Forum member, please write name:____________________
        If not referred, how did you find out about our organization: _____________________

       We would appreciate using only your e-mail for all correspondence on in order
          to contain costs. If you don’t have an e-mail address, we will send you paper mail.
          ___I wish to receive all correspondence via e-mail. ___Please send me paper mail.
        (1)   should your application not be approved, your payment will be promptly refunded
        (2)   if you are seriously interested in Membership, but would like to try a dinner
       first, you may pay a Guest Fee of $65 which will be applied to your annual dues if you
       pay the balance of $210 by the end of the October 28 meeting.