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Scholarship Club Membership Form


Wyoming Bucking Horse

 

SCHOLARSHIP CLUB MEMBERSHIP FORM

If you would like to join the University of Wyoming Alumni Association Scholarship Club, you can pay by credit card by filling out the form below Or calling our office at: (307) 766-4166.
You may also dowload a mail in form here.

Individual ($100/year/5years)

 

Outstanding Contributor '15' ($100/year/15years)

 

Philanthropic '20' ($100/year/20years)

 

Philanthropic '25' ($100/year/25years)

 

Patron ($500/year/5years)

 

Outstanding Patron ($500/year/10years)

 

Outstanding '15' Patron ($500/year/15years)

 

Benefactor Patron ($1000/year/5years)

 

Organizational Member/Corporate Benefactor
($500/year/5years)

 

Corporate Benefactor/ Patron ($1000/year/5years)  
General Donation  

First Name (required)

Middle

Last Name (required)

Street Address (required)

 

 

City USA (required)

State USA (required)

Zip Code USA (required)

Phone Number USA

Foreign City Zip

Foreign Country

Foreign Phone Number

Your E-Mail address

Membership Type Desired:

Name(s) you want on your plaque?

Credit this membership
to :(If Applicable)

   
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SRG 2006