2013 Membership Form

The Membership Form must be completed by Wednesday, July 24, 2013.

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

First Name *	Last Name *	Membership Status *
		New Returning

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

Home Address *	City *	State *	ZIP Code *

Date of Birth *	Cell Phone *	Home Phone

Email Address *	Campus Address(Fall '13)*	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 '13) *	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
Dietary Restrictions *
None

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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