University of Washington
STREET ADDRESS _______________________________________________
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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