Membership Dues Coupon           University of Washington Faculty Auxiliary
                   Membership Registration


NAME  ______________________________________________________________       

STREET ADDRESS  ___________________________________________________

CITY  ________________________ZIP CODE________ PHONE_______________

E-MAIL ADDRESS (Print VERY clearly, please)  ___________________________

YOUR DEPARTMENT IF YOU ARE FACULTY  ___________________________

PARTNER'S NAME  ____________________HIS/HER DEPT.________________

MEMBERSHIP CATEGORY

           REGULAR MEMBER  __________  (Faculty/staff or partner thereof)
           FRIEND   ______________________ 
(All others)

            Are you a first-time member? ______  Renewal?  ______   Rejoin? _______

Dues are applied to the operating expenses of the organization, as well as to other appropriate purposes as specifically defined in the UWFA Bylaws.  Dues are for the fiscal year beginning June 1.  Prompt payment of dues will ensure inclusion in the current  Directory published each October.

     $20 SINGLE MEMBERSHIP                                    $___________________
     $30 COUPLES (JOINT) MEMBERSHIP                 $___________________

SCHOLARSHIP DONATIONS:  We have provided full scholarships to UW undergraduate students for nearly 50 years.  Your contribution will help to continue this valuable service.

     SCHOLARSHIP DONATION                                    $__________________
 
     TOTAL ENCLOSED (DUES PLUS DONATION)    $__________________

Please make your check payable to and mail with form to UW Faculty Auxiliary, The University of Washington, Box 353070, Seattle WA  98195           
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