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this form IN FULL DATE___________________ PLEASE ENROLL ME (__) OR RENEW MY MEMBERSHIP (__) IN THE UofL SOUTH FLORIDA ALUMNI CLUB THROUGH AUGUST 31, 2010 Member Name___________________________________________ Co-Member____________________________________________ (Please Print) First Last (If Household Membership) First Last ____________________________________________________________________________________________________________ Home Address City State Zip Home Phone(______)_______________________ EMail________________________________________________________________ UofL Degree(s), Year(s): Member_______________________________________ Co-Member__________________________________ Enrollment name if different Member(__) Co-Member(__) _______________________________________________ Non-graduate but attended UofL: Member (date)______________________________ Co-Member (date)__________________________ Adopted Alumni Society Member (___) Co-Member (___) (___) Did not attend UofL but I am a Loyal Friend and Ardent Supporter (___) Golden Alumni Society (___) L Club member - Sports and Years____________________________________________________ My check made to: U of L South Florida Alumni Club MAIL TO: in the amount of $____________is enclosed OFFICE OF THE TREASURER ($20 Individual Membership)($25 Household Membership U of L SOUTH FLORIDA ALUMNI CLUB includes member, co-member and all residents under 941 CRYSTAL LAKE DRIVE #404 18 years old at same address) POMPANO BEACH, FL 33064 Member's Business, Profession, Product, or Service____________________________________________________________________ Business or Employer's Name_____________________________________________________________________________________ Address________________________________________________________ City, State, Zip__________________________________ Job Title/Specialty_________________________________ Phone (___)___________________ Email___________________________ Co-Member's Business, Profession, Product, or Service_________________________________________________________________ Business or Employer's Name_____________________________________________________________________________________ Address________________________________________________________ City, State, Zip__________________________________ Job Title/Specialty_________________________________ Phone (___)___________________ Email___________________________ Please DO (___) Please DO NOT (___) list the above employment information in the club's annual commercial directory. Business cards requested Please attach here __________________________________________________ Member's Signature |