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Northern Illinois University

College of Business - NIU

NIU Rockford Club Application

Please complete and submit the following online application. Membership dues are $25.00 for a regular membership and $100.00 for a leadership membership. The $100.00 leadership membership fee includes $75.00 designated for endowed scholarship fund. Please click on the link below to send in your credit card information or call 1(815) 753-5400 to provide this information. We cannot accept credit card information online.

If you have any questions regarding this form or the NIU Rockford Club, please contact Sue Braffet.

Use credit card and fill in PDF file.

PERSONAL INFORMATION:

First Name:   M.I.:   Last Name:
Preferred "Nickname":
Home Address:
City:
State/Province:   Postal Code:
Country:
Home Phone:
Email:

EDUCATION:

1st Degree - Institution
Degree
 Year
 Major
2nd Degree - Institution
Degree
 Year
 Major
3rd Degree - Institution
Degree
 Year
 Major

COMPANY INFORMATION:

Company Name:
Company Description:
Company Web Address:
Position Title:
Work Address:
City:
State/Province:   Postal Code:
Country:
Work Phone:
Fax:
Assistant Info: