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Membership Application Form

Apply for or renew your club membership by completing and submitting the form below.

Register me for the a 2007 membership ($10)
Register me for the a 2008 membership ($10)

(Optional) Tax deductible donation
Amount of additional donation
Please use my donation for  

(scholarships, special requests, no preference, etc)

 

Name
Graduation Date (Year only)
Degree
Address
E-mail
Phone
Comments/other

I have questions about this form and would like someone to contact me.

In order for your application to be approved you will need to mail payment to the club Treasurer.

Attn: Dustin Kaap
Treasurer, UW Alumni Club of Rockford
2057 Valencia Drive
Rockford, Illinois 61108

Make checks payable to: UW Alumni Club of Rockford

 

 

Send mail to webmaster@rockfordareabadgers.org with questions or comments about this web site.
Last modified: August 09, 2006