Membership App/Renewal

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Membership Dues Application/Renewal

2009-2010

School/Company: ______________________________________________________

Street/Mailing Address: _________________________________________________

City/State/Zip: ________________________________________________________

Contact Name: ________________________________________________________

Phone#:__________________________ Fax#: ___________________________

Email: _______________________________________________________________

Please check membership type – for Institutional and Benefactor memberships, please list names of staff covered under this membership of back of this form.

o $50 Individual Membership

o $75 Institutional Membership

(Two to four individuals from the same college or university)

o $100 Benefactor Membership

(Five or more individuals from the same college or university)

o $300 Supporting Membership (Vendors)

($200.00 for vendors who are renewing membership from 2009-2010)

If paying by check, please make check payable to USPA and mail dues form and check to:

University Surplus Property Association (USPA)
Attn: dELL Burnham

Dept. 3314, 1000 E. University Ave.

Laramie, WY 82071

If paying by credit card, please mail dues form to address above or fax to dELL Burnham at 307-766-6762

UMethod of Payment:

o Check (Check No: ________)

o Visa o MasterCard

Credit Card Number: ________________________________________________________

Expiration Date: ___________

Name of Cardholder: ___________________________

Signature of Cardholder: ________________________

UCredit Card Billing Address:

Street/Mailing Address: _______________________________________

City/State/Zip: ______________________________________________

Dues are through June 30, 2010 – Paid members will receive a discounted conference fee for the 2010 Conference hosted by the University of Connecticut.

Please list names of individuals covered under an Institutional or Benefactor Membership