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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:  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: