Student & New Graduate Lifetime Membership

Student Information First Name Middle Initial Last Name Name on Card Student ID Number Mailing Address City: State: Zip: Phone (xxx) - xxx-xxxx: Email: Month of Graduation: Year of Graduation:

Billing Information

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First Name: Last Name: Billing Address City: State: Zip Phone (xxx) - xxx-xxxx: Email: Where should the membership card be sent?

Notes/Promo Code:

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Total Charge $

If you have questions regarding the above application, please contact our offices at (608) 262-2263.

Student & New Graduate Lifetime Membership

Union Building Addresses

Union South

Memorial Union