Membership Form
College of Pharmacy Alumni Association
The University of Texas College of Pharmacy Alumni Association is the only membership association
that is dedicated to promoting your alma mater as an exemplar institution for education, research, and
public health initiatives. It strives to maintain strong connections among its Longhorn alumni and
support current students in their professional and academic endeavors. Membership dues strengthen
the College of Pharmacy’s programs and operations, and help you stay connected.
Please fill out this form and send it with your membership dues. You will receive a membership packet in the
mail. *If you have already paid online, you may e-mail this completed form to vanderson@austin.utexas.edu.
Name__________________________________________________________________
Address________________________________________________________________
City/State/Zip___________________________________________________________
Telephone____________________________Email_____________________________
_____ I have already paid online _______________ Date Paid
_____ I’ve enclosed $350 for a Lifetime Membership
_____ I’ve enclosed $175 for a Recent Graduate Lifetime Membership (only eligible for
2015, 2014, and 2013 graduates)
_____ Sign me up for a $35 Annual Membership for the 2015-2016 year
Mail this form and your check to:
The University of Texas at Austin College of Pharmacy
Office of Development and Alumni Relations
ATTN: Virginia Anderson
2409 University Avenue, A1900
Austin, TX 78712-0120
Checks can be made out to “The University of Texas at Austin.”
Paying by credit card? Visit: http://www.utexas.edu/pharmacy/dean/alumni/membershipform.html
Questions or suggestions? Please call or email Virginia Anderson: (512) 475-9759 or
vanderson@austin.utexas.edu