Membership Dues
              Coupon           University of Washington Faculty Auxiliary
                   Membership Registration

NAME  ___________________________________________________________        

STREET ADDRESS  _______________________________________________

CITY  ____________________________________________________________

ZIP CODE  _______________   PHONE  _______________________________

E-MAIL ADDRESS  ________________________________________________

YOUR DEPARTMENT IF YOU ARE FACULTY  _______________________

SPOUSE'S NAME  _________________________________________________

           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         
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