THANKS FOR JOINING!

Annual club dues from July '08 through June '09 are $20.00 for singles and $25.00 for couples. Dues payments made after April 1st will additionally credit towards the following year's dues.

Note that to encourage club membership U of I graduates from the past three years are exempt from dues, as are members who graduated 50+ years ago.

After completing this form, and clicking SUBMIT please make your check payable to the UIAC of Houston and mail it to:

UIAC of Houston, Attn: Membership
P.O. Box 542314
Houston, TX 77254

Please provide the following contact information, where access will be restricted to Club officers' (periodically shared with the UIAA.) Note that bold blue labels indicate required information. Thanks!

Member's First Name

Member's Last Name

E-Mail address

Secondary E-Mail address
(Note - while not necessary, please provide to ensure the club's ability to contact you should your primary email become inactive.)

Address

City

State

Zip/Postal Code

Home Phone

Work Phone

FAX

Campus

Class of (graduation year)

Degree (e.g. B.S., M.S., M.B.A., Ph.D., etc.)

Curriculum (e.g. Chemical Engineering, Business, etc.)

Non-U of I Class, Degree, and University

Home town, home state

High School

Employer

I am interested in serving as a club (use the control key to select more than a single item):

I am eligible to be exempted from dues since I graduated from U of I either within the last three, or more than 50 years. My last U of I degree was in:

The following is optional information for married club members:

Spouse's Name (First)

Spouse's Name (Last)

Spouse's E-Mail address

Spouse's University

Spouse's Class

Spouse's Degree

Spouse's Curriculum

Spouse's Home town, home state

Spouse's High School

Spouse's Employer

Spouse's Work Phone