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MBA Membership Application

Please fill in all fields and click submit at the bottom of the form or print this application and send it in to the address below. If you choose to submit the application online please select a method of payment and follow up accordingly.

Full name (first, mi, last)(*)
Please type your full name.

Year(s) of Graduation(*)
Please fill in your Year(s) of Graduation.

Preferred name:(*)
Please type your preferred name.

Name of spouse (if applicable)
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Address

Street 1(*)
Please enter your street address.

Street 2
Please enter your street address.

City(*)
Please enter your city.

State(*)
Please enter your state.

Zip Code or country:(*)
Please enter your zip code or country.

Telephone(*)
Please enter your telephone number.

Business Information

Thank you for your interest in UAB. You should receive an information packet in the next 1-2 weeks.

Your Title
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Business name:
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Street Address 1
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Street Address 2
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City
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State
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Zip code or country:
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Telephone:
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Fax
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(*)
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Email address:
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You may publish my name and business information in a password protected directory on the MBA Alumni Association Web site.

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Check all in which you would participate:

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Frequency of Events:

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Suggested locations for social activities

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Other suggestions or comments

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Other suggestions or comments


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Payment Information

If you plan to send in a check or money order, please enter your name in the field, check the box and click submit. Then make your check out to UAB National Alumni Society-MBA and mail it to:

UAB School of Business
Office of Development, Alumni, and External Relations
BEC 217E
1530 3rd Avenue South
Birmingham, AL 35294-4460


____Visa ____Mastercard ____ Discover

Card # ___________________ Expiration Date __________

Name as printed on card __________________________

I hereby authorize the UAB National Alumni Society to automatically charge my annual membership dues to my credit card each year in the month of _________________________

Signature of authorization: _________________________