Board of Fellows Application


 Membership Proposal and Application
~ All applications must be reviewed and approved by the Board of Fellows Membership & Steering Committees ~
The Board of Fellows Annual Financial Commitment is $1,250
($250 membership dues and a minimum of $1,000 towards UT’s Annual Fund)

* Denotes required field.  
*Applicant's Name: Prefix: 

First: 

Middle:

Last:

Business

*Title:
*Company:
*Describe Firm's Activity:
*Business Address:
*City:
*State:
*Zip:
*Email Address:
*Website Address:
*Business Phone:
*Cell Phone:
*Fax:
*I Prefer Mail be Sent to My:   

Personal

*Home Address:
*City:
*State:
*Zip:
*Home Phone:
*Applicant's Birthday: ( ex: MM/DD/YY )
*Education:(Check all that apply)

Other:  

*College Name/Degrees/Years: Degree 1:

Degree 2:

Degree 3:
*Are you a UT Alum?:

*Is your spouse a UT Alum?:
               

Spouse's Name:
*Professional or Service Club Affiliations:  
 *Interests:  
*Proposed/Referred By:
*Why do you want to join the Board of Fellows?