Member Identification Number / UH PeopleSoft ID
Please fill out all sections of this form.
If you have any question about filling out this form or any other
ABSA matter please email vpoperations@uhabsa.org
Basic Information
First Name
Last Name
UH PeopleSoft Identification Number
Date of Birth
Sex
Male
Female
City, State, & ZIP
Address
Classification
Expected Graduation Date
Freshman
Sophomore
Junior
Senior
Graduate
E-mail Address (Not UH E-mail if possible)
Phone Number
Major
Double Major / Minor
OK to receive text messages from us?
Yes
No
Quick Questions
How did you hear about ABSA?
Why are you joining ABSA and what do you hope to accomplish within this organization?
Would you like to join the ABSA Family Mentorship Program?
Yes
Would you like to be part on the official ABSA Intramural Sports Team? Include sports that you are interested in playing
No
Yes
No
Club Information
Name of ABSA member who referred you
Names of other ABSA members who referred you
T-Shirt Size
X Small
Small
Medium
Large
X Large
XX Large
XXX Large
Membership Dues
Payment Amount
$40 per Semester
Payment Type
Other Amount
Cash / Credit
Check Number
Check
For Officer Use Only
Officer Name
Total Amount Paid
Officer Signature
Date
Receipt Number
ABSA002.03 ABSA Membership Application