Name:

Maiden:

Address:
City: State: Zip:

Telephone Number:

Home:
Business:
Email:

Degree(s):
Major(s):
Year Graduated:

Graduate    Former Student    HU Faculty/Staff

HUAA Annual Dues:
$35 per person for one year, and $105 per person for three years
Make check or money order payable to Howard University Alumni Association (HUAA)

Check Type of Payment:

Visa    MasterCard    American Express    Check/Money Order

Credit Card Number:    

Exp. Date

CVS Number

Signature:    

Date: