Membership Application Form – The University Club of Winter Park

Please fill out the following form with all your details, and pay the $25 application fee. You can pay via the website or chose the pay latter option to pay directly at the club. If you already did this step and are waiting for confirmation please contact the club at info@uclubwp.org.

If you are currently a member and are doing this for someone else please make sure you are logged out. Logout

The membership committee will review of the application and get back to you with further instructions.

Membership Application

Contribution Amount *

Application Fee - $ 25.00

Total Amount

Email Address *

Membership Application

Personal Information

First Name

Last Name

Gender *

Female Male Prefer not to tell

Birth Date *

Marital Status *

Phone *

Address

Street Address *

Address Line 2

City *

State

Postal Code

Emergency Contacts

Emergency Contact 1 Name *

Emergency Contact 1 Phone *

Emergency Contact 2 Name

Emergency Contact 2 Phone

Emergency Contact 3 Name

Emergency Contact 3 Phone

Education

First College/University Name *

First College/University Degree *

First College/University Graduation Year *

Second College/University Name

Second College/University Degree

Second College/University Graduation Year

Third College/University Name

Third College/University Degree

Third College/University Geaduation Year

Societies

Professions/Careers

First Profession *

Second Profession

Additional Information

Personal Biography

How did you hear about the club *

Sponsored applications must be endorsed by two Club members. If you do not know any members to serve as sponsors, the Membership Committee will arrange for you to meet with two members.Please include the name of your sponsors in your answer.

Additional comments

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *