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Faculty Club Membership Application

 
Please complete the following pages so that we may receive and acknowledge this transaction as quickly and easily as possible. The UT Foundation assures you that all sensitive data and personal information involved in the online process is handled through our secure server.
1. Enter your biographical info:
Required First Name:
Required Last Name
Required Campus:
Required College:
Required Department::
Required Home Address:
Required City:
Required State:
Required Postal Code:
Primary Phone:
Other Phone:
Membership information:
   
Membership Type: New Member ($35.00)
Renewing Member ($35.00)
Retiree Member  ($10.00)
Administrator Member ($35.00)
$
   
Additional gift in support of the Faculty Club Scholarship: $
Total amount:
$
Special instructions:
 
Enter your credit card information:
Please enter the funds in US dollars.
We cannot guarantee that letters such as these (é, ú, â, ô, ñ, ö, ç,) will be processed correctly through the credit card processor. When typing, please do not use characters such as these. If you need assistance, please call our office at 419.530.7730.
Credit Card Type
    Visa MasterCard   American Express
Online Payments
Card Number
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Expiration Date /  
   
Billing information Same as above Not Same  
Billing First Name
 
Billing Last Name
 
Billing Address
 
Billing City
 
Billing State/Province

 
Billing Postal Code
 
Billing Country
 
Submit this form
     

(Please do not submit the same page more than once.
Doing so could result in multiple charges to a credit card.)

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For questions about this webpage, please call our office at 419.530.7730 or email us at utfoundation@utoledo.edu