University of Washington Faculty Auxiliary                    Membership Registration

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NAME  ___________________________________________________________         STREET ADDRESS  _______________________________________________ CITY  ____________________________________________________________ ZIP CODE  _______________   PHONE  _______________________________ E-MAIL ADDRESS  ________________________________________________ YOUR DEPARTMENT IF YOU ARE FACULTY  _______________________ SPOUSE'S NAME  _________________________________________________        MEMBERSHIP CATEGORY:            REGULAR MEMBER  __________  Faculty or spouse of faculty            FRIEND  ______________________  OTHER  ______________        Are you a first-time member? ___________  Rejoin?  __________   Renewal? ___________ Dues: Dues cover only expenses incurred by the organization.  Dues are for the fiscal year beginning June 1, 2012 to May 31, 2013.  Prompt payment of dues will ensure being included in the 2012-2013 Directory.            REGULAR ______  $20 Single membership     JOINT ______  $30 Couple SCHOLARSHIP DONATIONS:  We have provided full scholarships to UW undergraduate students for over 40 years.  Your contribution will help to continue this valuable service.         SCHOLARSHIP DONATION:  $ _____________ (amount)                                                                 $ _____________ (Total: Dues + Scholarship Donation) Please make your check payable to UW Faculty Auxiliary.  Mail your check and this form by June 15th to: Faculty Auxiliary,  Treasurer, The University of Washington, Box 353070, Seattle, WA, 98195-3070          Return to Membership Page