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Reynolds Historical Library |
Reynolds Associates Membership Form
Name _________________________________________________________
Address _______________________________________________________
City _____________________________________State _____ Zip ________
| ____ Student Associate | $10 |
| ____ Contributing Associate | $25 |
| ____ Sustaining Associate | $50 |
| ____ Sponsoring Associate | $100 |
| ____ Fellow Associate | $500 |
| ____ Patron Associate | $1,000 or above |
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Please accept my additional donation of $ ___________ |
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____ I prefer to join with my enclosed check payable to UAB
____ I prefer that my credit card be charged o Visa o MasterCard o Discover o American Express Total Gift $________________ Credit Card Number _____________________________________________________ Expiration Date ________________________ Name on Card _________________________________________________________ Signature _____________________________________________________________
Send Form to: UAB Gift Records Office 1530 3rd Ave S - AB 1230 Birmingham, AL 35294-0112
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