Please complete this form and mail along with your check to the address below.
Chapter Membership cost: Family-$35.00 _________ Individual-$25.00 __________
Note: Family membership includes husband, wife, & school age children; membership is annual from August 1st to August 1st.
Name: ______________________________________________________________
Alabama graduate? Yes ____________ No ____________ Degree/Major _______
Spouse: ____________________________________
Alabama graduate? Yes ____________ No ____________ Degree/Major _______
Address: ____________________________________________________________
Home Phone: ________________________________________________________
Email Address: _______________________________________________________
Children’s Names & Ages ________________________________________________
Children/Grandchildren attending University _________________________________
Number attending the Membership Meeting/Kick-Off August 23rd __________________________
Willing to serve as a chapter officer/worker?
Yes ____________ No _____________
Make check payable to UA Dale County Alumni Chapter, and mail along with this form to: UA Alumni Dale County Chapter, P.O. Box 238, Ozark, AL 36361
For information contact Ronald Wright, (334) 618-4140 or (334) 618-8258