Name:

Department:

ASU Mail Code: E-mail Address:

Phone:    Fax:

Work Location (building and room): 

Year You Started at ASU:

Supervisor's Name/Title:

Personnel Classification (check one that applies) 
Academic Professional
Administrative Staff
Classified Staff
Faculty
Service Professional
Student, undergraduate
Student, graduate 
Alumni (Retiree) 

How were you referred to UCW?
Another Member
Web site
Other (please specify) 

Membership status:
New
Renewal
Original membership year: (renewals only) 

Events/Activities:

Let us know if you would be interested in being on the planning team for any of the various UCW events and activities throughout the year. Our events only happen through participation from our members! See our Events page for more details about each of these events.

Fall Luncheon Spring Luncheon Lunch N' Learn

Ice Cream Social Java Jazz Holiday Coffee

Women's History Month ASU Homecoming

Adopt A Family Donation Drives Other (specify in box below)

If there is an event you would like to see UCW plan, please include a description.

I will be paying by PO*
I will be paying by check**

PO or check number: 

I need financial assistance (we will contact you personally to work out details) 

Send your payment to the current Financial Coordinator on the UCW Board.

I would like to add $ as a donation to the STAR Fund (Skills/Training/Assistance/Resources) 

*The vendor code for PO documents is UNIVCAREER
**Please make checks payable to University Career Women.