UB Alumni Association Membership Application

Please complete the information below, then print the form to your local printer and fax or mail it back to us. If you prefer to pay by credit card, an online application is available for immediate, electronic submission through our secure server. If you have questions, call 1-800-284-5382 or email ub-alumni@buffalo.edu

Required Information:
Last Name, First Name


Name Used While Attending UB (if different than above)


Class Year(s) Major(s)

Home Address


City State Zip Code
Home Phone
E-mail Address

Type of Membership (US $):
Annual Single, $40
Annual Dual, $50 (2 UB Alumni living at the same house)
Life Single, $750
Life Single, $150 (first annual installment toward $750 total)
Life Dual, $1000
Life Dual, $200 (first annual installment toward $1000 total)
Recent Graduates Annual Single, $30 (Special discount for the classes of 2005, 2006 and 2007)

Joint Membership Programs:
School of Engineering and Applied Sciences
Annual Single - $50
Annual Dual - $60 (1 engineering graduate and 1 UBAA graduate living at the same address)
Annual Dual - $85 (2 engineering graduates -or- 1 engineering graduate & 1 pharmacy or management graduate living at the same address)
Annual Dual - $80 (1 engineering graduate and 1 social work graduate living at the same address)

School of Management Graduates
Annual Single - $50
Annual Dual - $60 (1 management graduate and 1 UBAA graduate living at the same address)
Annual Dual - $85 (2 management graduates -or- 1 management graduate & 1 pharmacy or engineering graduate living at the same address)
Annual Dual - $80 (1 management graduate and 1 social work graduate living at the same address)

School of Pharmacy and Pharmaceutical Sciences Graduates
Annual Single - $50
Annual Dual - $60 (1 pharmacy graduate and 1 UBAA graduate living at the same address)
Annual Dual - $85 (2 pharmacy graduates -or- 1 pharmacy graduate & 1 management or engineering graduate living at the same address)
Annual Dual - $80 (1 pharmacy graduate and 1 social work graduate living at the same address)

School of Social Work Graduates
Annual Single - $40
Annual Dual - $50 (1 social work graduate and 1 UBAA graduate living at the same address)
Annual Dual – $70 (2 social work graduates living at the same address)
Annual Dual - $80 (1 social work and 1 engineering, 1 management or 1 pharmacy graduate living at the same address)

* 3- and 5-year memberships are available for a discount. Please contact the alumni office for more information at 1-800-284-5382.

Select method of payment:
Visa Mastercard Discover American Express
Check, payable to UB Alumni Association Money Order

Credit Card Number Exp. Date
Signature of Cardholder

Required Information for Dual or Family Memberships:
Spouse Last Name, Spouse First Name
Spouse Maiden or Former Name
Spouse Class Year(s) Spouse Major(s)
Name of Additional Family Members Joining
Relationship to Member



Employer Information (optional):
Employer
Job Title
Employer Address


City State Zip Code
Work Phone
Fax


Please Print out this form and mail or fax it to the Office of Alumni Relations:

Alumni Home