Pay By Mail Membership Application
Please print out and complete this form and mail it with your check to:
Membership
Alumni Association - 1120
UCSB
Santa Barbara, CA 93106-112
 
Your Information
Social Security #
(last 4 digits only)
 __________________

Title

 __________________
First Name _____________________________________________
Middle Name _____________________________________________
Last Name _____________________________________________
Last Name as Student _____________________________________________
Home Address _____________________________________________
City _____________________________________________
State _____________________________________________
Zip _____________________________________________
Home Phone _____________________________________________
Email _____________________________________________
Year of Graduation _____________________________________________


Please Specify Your Primary UCSB Affiliation
____Alumni of UCSB Degree________ Major____________________
____Student of UCSB
____Friend of UCSB

Spouse (Domestic Partner) Information
A free joint membership is available to your spouse/partner if they are a UCSB graduate and reside at the same address.

First Name

 __________________________________________
Middle Name __________________________________________
Last Name __________________________________________
Last Name as a Student __________________________________________
Year of Graduation __________________________________________
Email __________________________________________
 
Membership Type
_____ Life Membership $500 - One payment
_____ Life Membership Installment Plan - $600 - Three payments of $200/yr
_____ E-Z LIfe Monthly Installment Plan* - $540 - $60 a month for nine months
_____ New Grad Life Membership - $400 - One payment - Lifetime membership for current students or alumni within one year of graduation (Save $100)
_____ New Grad Life Installment Membership - $500 - Four annual payments of $125 for current students or alumni within one year of graduation
_____ Student Life Membership - $500 - One payment
_____ Student Life Installment Membership - $500 - Four payments of $125/yr
_____ Golden Gaucho Life Membership - $400 - One payment - 60 years of age and older
_____ Two-year Membership $90 - One payment
_____ Golden Gaucho Two-Year Membership - $55 - One payment - 60 years of age and older (Save $45 from normal annual membership)
_____ New Grad Two Year Membership - $55 - Two year membership for current students or alumni within one year of graduation (Save $45 from normal annual membership)
_____ Annual Membership - $50 One payment - One year membership
_____ Golden Gaucho Annual Membership - $35 - One payment - One year membership for 60 yrs. of age and older (Save $15)
_____ New Grad Annual Membership - $35 - One year membership for current students or alumni within one year of graduation. (Save $15)
    *E-Z Life Payment Plans - Credits cards only. Card will automatically be charged $60 per month for the next nine months.
   
Method of Payment
_____ Check enclosed (Make check out to UCSBAA)
_____ Visa 
_____ Mastercard
  Credit Card # __________________________________________
  Expiration: __________________________________________
  Signature: __________________________________________
  Mail to:
  Membership
Alumni Association - 1120
UCSB
Santa Barbara, CA 93106-1120