Gift of 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 recipient’s membership dues. They 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.
RECIPIENTS INFORMATION:
Name__________________________________________________________________
Address________________________________________________________________
City/State/Zip___________________________________________________________
Telephone____________________________Email_____________________________
GIFT GIVERS INFORMATION:
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)
_____$35 Annual Membership for the 2015-2016 year
Paying by credit card? Visit: http://www.utexas.edu/pharmacy/dean/alumni/membershipform.html
Checks can be made out to “The University of Texas at Austin.” 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
*Gift of Membership-Enter message to your gift recipient: