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UAB National Alumni Society Membership Application

Thank you for your support of the UAB National Alumni Society!

With your membership we are able to provide quality programs and services to our alumni and current students. Thank you for helping us build an even stronger alumni family and make a lasting impact on our UAB campus and community!

By getting involved and becoming a member you are not only staying connected to your Alma Mater, you also show your support of UAB and allow the NAS to continue to give back. The UAB National Alumni Society is proud to partner with our schools and colleges in raising over one million dollars from alumni to provide student scholarships.

A portion of your membership benefits student scholarships, athletic programs, and is tax-deductible.

Membership Type:(*)
Membership Type required

As a UAB employee, would you like to use payroll deduction as your method of payment for your membership.
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Would you like your membership to auto-renew?(*)
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Classification(*)
Classification required

Information for First Member

(*)
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Preferred Name
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Middle Initial
Middle Initial required

Last Name(*)
Last Name required

Suffix
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Last Name While Attending UAB
Name While Attending UAB required

Birthdate(*)
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Email(*)
Email required

Cell Phone(*)
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Blazer ID
Blazer ID required

Home Address (*)
Home Address required

City(*)
City required

State(*)
State required

Zip Code(*)
Zip Code required

Information for Second Member

(*)
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Preferred Name
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Middle Initial
Middle Initial required

Last Name(*)
Last Name required

Suffix
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Last Name While Attending UAB(*)
Last Name While Attending UAB required

Graduation Year(s)(*)
Graduation Year required

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Are you a UAB employee or UAB student?(*)
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Are either members of your Joint Membership Application a UAB employee or UAB student?
(*)
Answer required

For an additional fee of $5 each, I would like to include a UAB Campus Parking Pass
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For an additional fee of $5, please include a UAB Campus Parking Pass
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Information for First Vehicle
Tag Number(*)
Tag Number required

Vehicle Year(*)
Vehicle Year required

Vehicle Make(*)
Vehicle Make required

Vehicle Model(*)
Vehicle Model required

Vehicle Color(*)
Vehicle Color required

Information for Second Vehicle
Tag Number(*)
Tag Number required

Vehicle Year(*)
Vehicle Year required

Vehicle Make(*)
Vehicle Make required

Vehicle Model(*)
Vehicle Model required

Vehicle Color(*)
Vehicle Color required

Alumni Chapter Selection

MBA Members automatically join the MBA Chapter. Additional chapters are $15.00 each.

If you would like to join an alumni chapter, please select one from the list below. If you select OTHER, please enter your choice in the textbox provided:
Student Members automatically join the Student Alumni Society. Additional chapters are $15.00 each.

If you would like to join an alumni chapter, please select one from the list below. If you select OTHER, please enter your choice in the textbox provided:
Employee Members automatically join the Employee Chapter. Additional chapters are $15.00 each.

If you would like to join an alumni chapter, please select one from the list below. If you select OTHER, please enter your choice in the textbox provided:
Junior Members automatically join the Young Alumni Chapter. Additional chapters are $15.00 each.

If you would like to join an alumni chapter, please select one from the list below. If you select OTHER, please enter your choice in the textbox provided:
You may choose one complimentary chapter as part of your membership. Each additional chapter selection is $15 each.

If you would like to join an alumni chapter, please select one from the list below. If you select OTHER, please enter your choice in the textbox provided:
Affliation Chapters
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Geographic Chapters
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Other:
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How did you hear about the UAB National Alumni Society memberships?

(check all that apply)

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Board Member's Name
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Other:
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Comments
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Thank you for your membership! A portion of your membership dues support student scholarships and is tax deductible. Membership dues are non-refundable.