Accounting Bulldog Circle

                                   Membership Application

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First Middle Initial Last

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Business Affiliation

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Title/Position

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Business Address

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City State Zip

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Home Address

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City State Zip

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Business Phone Home Phone

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Fax

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E-mail

I wish to become an Accounting Bulldog Circle member:

______ $2,000 individual annually

______ $5,000 corporate, two individuals

___ Enclosed is my check for $_________ made payable to the MSU School of Accountancy.

___ I authorize a draft of $________ on the following credit card:

_____________________                               ___________

                 Credit Card Number                                      Exp. Date

             _____________________________________________________
                                       Signature

___ My gift will be matched by my company.

Please direct all my mail to my

___ Business address ___ Home address