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UIAA Membership Renewal Application

Thank you for your continued support!
Did You Know? You may renew 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 the form below.

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 - Fields marked with an * are required.

*Name
(First, Middle, and Last):

*E-mail Address:

A valid e-mail address is REQUIRED for submission of this form.

University/Member ID
(if known):

Date of Birth:

Second Member's Name
(if applicable):

Second Member's
University/Member ID (if known):

Second Member's
Date of Birth:

*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

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's 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:

		Student membership in IOWA S.T.A.T. (Students Today, Alumni Tomorrow) For currently enrolled UI students only. Join Now!

	$25	Recent Graduate membership (For individuals who have graduated within the last five years)

	$45	Regular Annual membership

*All membership levels are considered family memberships unless otherwise requested.

Payment Options
*Please select one payment preference.

	Credit Card	Use the UIAA Bank of America Credit Card and support the university today! Apply!

	Card Number:
	Expiration Date:

Comments:

Promotion Code

If you have a promotion code, please enter it here.
Code Number:

For Security Purposes
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Please double check your e-mail 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