2012 Membership Form

Please fill out the following information as completely as possible.
If you have any questions, please email ucmb@uconn.edu.

First Name *	Last Name *

Peoplesoft Number *	NetID *
Provided at Orientation - if you don't have yours yet, write "Not Received"	3 letters and 5 numbers: abc12345

Home Address *	City *	State *	ZIP Code *

Date of Birth *	Cell Phone *	Home Phone

Email Address *	Campus Address *	Screen Name
	If you have not received your housing assignment enter "Not Received" If you are living off campus enter "Off Campus"

High School *	High School Band Director	Home Newspaper

UConn Classification (Fall '12) *	Expected Graduation *	Intended Major *

Primary Instrument/Color Guard *	Other Instrument(s)	Marching Experience *

Height *	Weight *	T-Shirt Size *
inches Does not need to be exact - used primarily to ensure we have the right number of uniform parts.	lbs

Do you receive Work Study as part of your financial aid package? *

Yes No

UConn Awards and Activities:

Any other information you wish the UCMB to know:

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