MEMBERSHIP ENROLLMENT FORM

July 1, 2017 to June 30, 2018

Name of Institution: ___________________________________________

Department URL: _____________________________________________

Address: ____________________________________________________

City: _____________________________ State: ______   Zip: ________

 Contact Person: _____________________________________________                       

Title: ______________________________________________________

Office: _____________________________________________________

Telephone Number: ______________________ Fax: _______________

Email Address: _______________________________________________

If there are additional individuals from your institution who would like to be on 
the CHERC list of member participants, please list them and their contact information 
on the back of the form.  There are no additional fees for added member participants. 

Membership Fee:  $135

Please submit via U.S. mail with your membership fee made payable to

 Villanova University/CHERC

and send to:  

Regina Sorgini

Office of Planning and Institutional Research (OPIR)

St. Mary's Hall - Room 110A

Villanova University, 800 Lancaster Avenue, Villanova, PA 19085-1699

         Phone: 610-519-4558                      e-mail: regina.sorgini@villanova.edu

If you prefer to pay by credit card please use

our NEW Option below!

ONLINE ENROLLMENT FORM