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Membership Registration Form and Dues Invoice for 2017
GPHC Tax ID No. 80-0502355
 
To assure proper crediting of your account, please print, complete, and return one copy of this invoice to:
 
Great Plains Honors Council
Carrie Pritchett, Executive Secretary-Treasurer
Brazosport College Honors Program
500 College Dr.
Lake Jackson, TX  77566
 
Institution:_____________________________________________________________________________________
 
Name:_____________________________________________________________________________________
 
Honors Title:____________________________________Degree/Discipline:____________________________
 
Mailing Address:___________________________________________________________________________
 
City, State, ZIP:_____________________________________________________________________________
 
Telephone:__________________________________________Fax:_________________________________
 
Email:________________________________________________________________________________
 
Program Type: ______Institution-wide Honors Program      _____Honors College        ______Dept. Honors
 
Number of Students in Honors Program:__________________
 
Select One:  _____Institutional Dues             ______Professional Dues
 
Payment Method:  _____Credit Card             ______Purchase Order/Check
 
Select One:  ______Sustainer Dues ($100)    _____ Dues ($50)           ______First-time Member Dues ($25)
 
Note: "Sustainer Dues" is a higher level of dues for GPHC membership with sufficient resources to help GPHC beyond the minimum charge.  We are very thankful for these higher-order contributions.  The sustainer dues received over the years have enabled the GPHC to establish a treasury that is secure enough to maintain our commitments and to launch new initiatives.