UCAS Registration Form
Type of membership
Single Family
Surname
Given name(s)
Name of spouse
Street address
City
Postal code
Phone #. at home
Phone # at work
Fax #
Email address
Spouse email address
Member since(year)
Occupation(s)
   
Names of children Age
 

Please check areas in which you would be willing to help the running of UCAS
(indicate name of individuals in case of a family membership)

Accounting/Bookkeeping
Publicity
Website maintenance
Archives
Database
Other

 
Membership fee Year 2005-06
Family membership ($25)  
Individual membership ($15)  
Student membership($10)  

 

Signature _______________________

 

Date mm/dd/yy