UCLA Faculty Women's Club Membership Dues

RSVP Information

Application Type
Please select the application type that applies.
Select	Description	Amount

	Renewal Application - $35
	New Application - $35
	Golden Members (85 years or older) - No dues required but always appreciated to help defray costs of printing, mailing, and providing refreshments. Please complete and return this form as it lets us know you still want to receive mailings.

Sub-Total:
Tax-Deductible:

Additional Contribution
Please enter any additional amount you would like to contribute
Quantity	Description	Amount

* *

Golden member optional contribution

Sub-Total:
Tax-Deductible:

* *

Grand Total:

Tax-Deductible:

Application Information
	* Please indicate your affiliation:	*

	If you are joining as a Guest Member, please give name of FWC member who is your sponsor:

	INTERESTS:
If your interest is not listed in the Sections pages of the Update or Webpage, please note it here for consideration as a new section.

	* Have you ever served on the FWC Board?:	*
	* Would you be interested in serving on the Board?:	*
	* Would you be interested in serving on an ad hoc committee:	*
	Cell phone:
	Email:

Contact Information

Personal

Title:

First name:

Middle name:

Last name:

Suffix:

I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor

Spouse/Partner

Name:

Contact Information

Street:

U.S. Addresses

City, State, Zip:

Non-U.S. Addresses

Non-U.S. City/County
or Province/Postal Code:

Country:

This address is my:

Home

Business

Home telephone:

Invalid phone number *

Business telephone:

Invalid phone number

E-mail address:

This e-mail is my:

Home

Business

Payment

If your transaction includes a payment, please select method.

Payment method:

Credit Card PayPal

Additional Information

	YES, please include my address, telephone, cell phone, and e-mail address on the FWC membership roster for distribution to FWC members. Note: Membership information is confidential and for FWC internal use only.
	If you have provided any new contact information, please check here.

Comments:

UCLA Faculty Women’s Club Membership Form 2023 -2024

UCLA Faculty Women’s Club Membership Form
2023 -2024