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UIAA Membership Application

You may apply for membership in the UI Alumni Association in any of the following ways:

Phone
Call 800/469-2586 (IOWALUM).
Mail
Complete and mail in the printable application.
Online
Complete and submit this form.

Life members click HERE.
Students applying click HERE.

Please be as complete as possible on your name. We ask that you include a middle name as there may be several people with names in common.

Personal Information

*Name:
(First, Middle and Last)

*E-mail Address:

University ID (if known):

Date of Birth:

Graduation year:

Degree received:

Second Member's Name
(if applicable):

Second Member's University ID (if known):

Second Member's
Date of Birth:

Second Member's Graduation Year:

Second Member's Degree Received:

I live in the United States.*

*Street address:

*City:

*State:

*Zip Code:

I do not live in the United States.*

*Foreign Address:
(Type line by line per postal requirements in your country.)

*Daytime Phone Number:

Membership Options*
Please indicate which level of membership you prefer-recent graduate, or annual.

	$25	Recent Graduate Membership (For new graduates and individuals who have graduated within the last five years)

	$45	Annual Membership

Want To Go Over and Above UIAA's Regular Membership? Consider The Directors' Club Honor Circle and the Old Capitol Club.

The Directors' Club Honor Circle and the Old Capitol Club exist for members wanting to contribute over and above their regular dues. This amount is considered a charitable contribution for tax purposes. You will be recognized in the UIAA and the UI Foundation's annual honor rolls.
	$1,000	Directors' Club Honor Circle

	$750-999	Old Capitol Club Platinum Membership Please enter amount of gift

	$500-749	Old Capitol Club Gold Membership Please enter amount of gift

	$250-499	Old Capitol Club Silver Membership Please enter amount of gift

	$100-249	Old Capitol Club Bronze Membership Please enter amount of gift
*All membership levels are considered family memberships unless otherwise requested.

Payment Options*
You must select one preferred method of payment.

	Credit Card	Use the Iowa Rewards credit card. Earn exclusive UI rewards while supporting the university. Apply!

	Card Number:
	Expiration Date:

Quick Question

What prompted you to join the UIAA?
	A personal desire to be connected with the UI
	A friend/relative suggested I join
	I saw an ad in the Iowa Alumni Magazine
	I received literature from the UIAA
	I received a phone call from the UIAA
	Made up my mind while visiting the Web site
	Other:

For Security Purposes
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* You must enter text from the image above.

Please double check your email address. Errors in entering it will delay our receipt of your application.


Apply!	UIAA Home \| Contact Us \| Advertising \| Privacy Policy 100 Levitt Center, Iowa City, IA 52242-1797 Phone: 319/335-3294 or Toll Free: 800/469-2586 FAX: 319/335-1079; Copyright © 2009	Partners