University Dames Membership Form

University Dames
Membership Form
To be considered a member of the Dames, and to receive all future mailings, please fill out this form and return it to
the address below by October 15th, with your annual dues of $20.00 (payable to University Dames) and Book
Scholarship donation (payable to UM Foundation).
University Dames
P.O. Box 2241
Oxford, MS 38655
Name:_________________________________________________________________
Address:_______________________________________________________________
Oxford, MS 38655 or Other _______________________________________
Telephone: ___________________ E-mail Address:__________________________
UM Department affiliation: You __________________________________________
Your Spouse/Partner ________________________________________
Circle the applicable membership category:
Newcomer
Renewal
Circle how you want to receive future UM Dames communications:
EMAIL
Regular Mail
Enclosed are:
2015-16 Dues
(payable to University Dames)
Tax-deductible gift to the Dames Book Scholarship fund
(Separate check - payable to: "UM Foundation")
$
20.00
$______________
TOTAL ENCLOSED
___ Cash ___Check
$______________
THANK YOU!