Gift Membership Form

Thank you for your interest in U.Va. Alumni Association membership. Please complete the following form to give membership as a gift to a family member or friend. Credit card information is secured by VeriSign digital encryption. Required fields are marked with an asterisk ().*
Personal Information
*Recipient Name:	*First	Middle	*Last
	Maiden
*Recipient Address:	*Street 1
	Street 2
	Street 3
	*City	*State	*Zip
	Country (if not U.S.)
	Telephone
This address is a:	Home Business
School and class:

Membership Type
If this is a joint membership gift, please provide:		Spouse Name	Spouse School/Class

Alumni Plans:	Annual Membership, Single - $35.00 Annual Membership, Joint - $45.00 Annual Membership, Year After Graduation - $25.00 Life Membership, Single - $400.00 Life Membership, Joint - $450.00

Student Plans:	Life Membership - $350.00

Non-Alumni Plans:	Annual Membership, Associate - $40.00 Life Membership, Associate - $450.00

Comments: (Please provide name of gift giver)

University of Virginia Alumni Association