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    Athletic Alumni Club Online Registration

    Please fill out the form below to apply for the Athletic Alumni Club.

    * Required Fields

    First Name *

    Last Name *

    Home Address *

    City *

    State *

    Zip *

    Home Phone Number

    Work Phone Number

    Email Address *

    Sport(s)

    Years (YYYY-YYYY)


    Check box if billing address is the same as membership address


    Billing Address for Credit Card

    City *

    State *

    Zip *


    Notes

    Verify characters:

    You will be redirected to the UICAAC page following successful submission of this form.