Bruin Affiliates Membership Dues

RSVP Information

Bruin Affiliates Membership Dues
Select	Description	Amount

	Individual Membership - $40 per person
	Family Membership - $60 per household

Sub-Total:
Tax-Deductible:

Donate to Our Scholarship Funds

If you’d like to contribute to UCLA Affiliates Scholarship or the Westwood Women's Bruin Club Scholarship please click the corresponding link to make a donation.

* *

Grand Total:

Tax-Deductible:

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

UCLA graduation year(s):

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

Payment method:

Credit Card PayPal

Additional Information

	* Additional family member:
	* Additional family member email:
	No, I do not wish to include my information on the Bruin Affiliates membership roster. Membership information is confidential and for Bruin Affiliates internal use only.

Comments: