UVI Alumni Association - Registration Form


	Alumni Update Form

Please mail to the address below or print and fax to (340)693-1045. (Type or print)

Legal Name:

___________________________________________________________________________________
Last Name First Name Middle Initial

Maiden or other name(s): _____________________ Social Security Number ___ - __ - ____

Mailing Address:

___________________________________________________________________________________
Address City State Zip Code Phone Number

Permanent Address:

___________________________________________________________________________________
Address City State Zip Code

Email Address ________________________________________________________

Class Year/ Period Attended UVI: _________________________________________

Home Phone: (_____) ______________ Business Phone: (_____) ___________________

Any immediate family members presently attending UVI? YES___ NO___

If yes, Name/Relationship: ________________________________________________________

I, ______________________________ hereby register as a member of the UVI Alumni Association

______________________________ Chapter and pay the:

_______ Annual membership dues of $25 to $35 (varies among Chapters) or

_______ Lifetime membership dues of $250 by December 31, 2004, and $500 thereafter

Signature ______________________________

Date _________________________________

UVI Alumni Association, c/o Alumni Affairs, #2 John Brewer's Bay, St. Thomas, VI 00802-9990
University of the Virgin Islands