Membership Form 2000-2001
The contents of this form is confidential and will not be shared with anyone outside of ASA Administration. You do not have to fill out any parts of this form that you feel uncomfortable with. Completion of this form is voluntary. Full completion helps us better serve your interests. Most information will be used in the ASA directory for distribution to members.
Personal Information
Last Name:
First Name:
Home Phone Number:
Home Address:
City:
State:
Zip Code:
Gender:
Male
Female
Year in school:
1st
2nd
3rd
4th
Major(s):
Ethnic Background:
Birthdate:
mm/dd/yy
Hobbies and Interests:
Information at UR
Box Number :
WC
RC
UFA (Number:
)
Address:
Phone Number:
Email Address:
Best time to have meeting (bi-weekly):
Mon
Time:
Tue
Time:
Wed
Time:
Thur
Time:
Fri
Time:
Weekend
Time:
Committee Interests
(check all that apply)
:
Cultural Affairs
Social Affairs
Fund-raising
Community Outreach
Publicity/Newsletter
All of the above
Activity Interests
(Activities you would like to see ASA provide)
: