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   Membership Application


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Name (Please list as you wish to be recognized in printed materials)

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Phone Number

__________________________________________________________________________________________________________ Mailing Address

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City

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State                                                                      ZIP

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Email Address

 

Membership Dues $50 annually


Please accept my annual contribution
at the following level:

Committee Preference:

Marie Curie $2500 and above

Annual Event

Florence Nightingale $1,000-$2,499

Education

Elizabeth Blackwell $500-$999

Membership

Clara Barton $499 and under

Resource Development

I prefer not to serve on a committee

For more information, call 904.620.2810

Total Check Amount $ __________   (Please make checks payable to the UNF Foundation)

Mail the completed form with your check to:

Leslie S. Greer
Assistant Director of Development
UNF, Brooks College of Health, Building 39
1 UNF Drive
Jacksonville, Florida 32224

A copy of the official registration and financial information may be obtained from the division of consumer services by calling toll free: (800-435-7352) within the state. Registration does not imply endorsement, approval, or recommendation by the state.