ISU Alumni Association Member ISUCard Form
Please complete this form and return it to the ISU Alumni Association in the attached
envelope or present this form and a photo ID to the ISUCard Office in 0530 Beardshear
Hall between the hours of 8:00 and 4:00, Monday through Friday to receive your ISU
Alumni Association ISUCard.
There is a $15 annual fee associated with this card and it is renewable on June 30th each
year. If you are mailing in your request to the Alumni Association, please make checks
payable to the ISU Alumni Association.
Social Security Number* _________________________________
Last Name ___________________________________________________
First Name ____________________________________________________
Middle Initial ______
Gender________
Birthday_______________________(MM/DD/YYYY)
Home Address __________________________________________________
City - State _________________
_________________
Zip Code ____________
Home Telephone Number __________________________
E-mail Address____________________________________
Expiration Date for Cardholder
06/30/2016
_______________________________
*Social Security Number Policy: Disclosure of our Social Security Number (SSN) is required of you in order
for Iowa State University to issue your ISUCard or any Identification Card. Federal and State law protects
the privacy and security of your SSN and Iowa State University will not disclose your SSN without your
consent for any other purposes except as allowed by law.
For a full description of the ISU Social Security Number policy, please see the Social Security Number
Protection Policy online at http://policy.iastate.edu/policy/ssn/.