Home Address:_________________________________________________

City:___________________________________     State:_________   Zip:_________________

MU Student #:_____________

Home Phone:(______)_______________    Business Phone:(______)_______________

E-mail address:________________@_______________________________________

Spouse's Name:_________________________________________    

Spouse's MU Student #:_____________

Annual Membership

$40 Individual (65 & older, $30)

$60 Dual (65 & older, $45)

$30 Faculty/Staff (Dual, $45)

$20 Student / True Tiger (Dual, $30)

$30 New Graduate - 2 years (Dual $45)

Please send information on Life Membership

Reminder:  Spouse does not have to be an MU Alum to be included in a dual membership!

Make check payable to the MU Alumni Association

     Or charge:  Visa      Mastercard     Discover

     Card number ________ - ________ - ________ -________       Expiration Date ____  / _____   

     _________________________________________________
     Signature                              (required for credit card payment)

Please return this form with your payment to:
MU Alumni Association
123 Reynolds Alumni and Visitor Center
Columbia, MO 65211