Membership Application

Name

Last Name *

First Name *

Middle Name/Initial

Previous Name

Name while in the College of Information

Personal Info

Degree(s) *

Graduation Year *

Month

Day

Year

Place of Employment

Title

Preferred Contact

Street Address

City

State

ZIP Code

Country

Phone Number

E-mail Address

Membership Type *

Student $10.00 (current students and first year graduates)

Annual $25.00

Lifetime $250.00 (list dates below for installment payment)

Method of Payment *

Cash

Check (please make your check payable to UNT Foundation)

Credit Card

As an Alumni Society Member, are you interested in serving as: (please check all that may apply)

Alumni Society Board Member

Host for Local Events

Mentor to Students

Something Else

If you chose Something Else, please expand here:

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