Bruin Affiliates October Luncheon

RSVP Information

Registration
Select	Description	Amount

	Members Only Event Ticket (active annual dues paid) - $45 (not tax-deductible)
	Regular Event Ticket - $50 (not tax-deductible)

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

Additional Information

	Job Title:
	Company Name:
	Does anyone in your party need ADA accommodations? (N/A if none):
	Does anyone in your party have any dietary restrictions? (N/A if none):
	* UCLA Affiliation:	*
	* Choice of entree:	*
Guest Information The following fields are required for all of your additional guests. If you are the main registrant, no need to include yourself below as we have your information above.
Your First Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
	UCLA graduation year:
	* Choice of entree:
Your Second Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
	UCLA graduation year:
	* Choice of entree:
Your Third Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
	UCLA graduation year:
	* Choice of entree:
Your Fourth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
	UCLA graduation year:
	* Choice of entree:
Your Fifth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
	* Choice of entree:
Your Sixth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
	* Choice of entree:
Your Seventh Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
	* Choice of entree:
Your Eighth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
	* Choice of entree:
Your Ninth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
	* Choice of entree:

Comments: