Membership Form - College of Medicine - UAMS Parents Club

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As a result of Your AmazonSmile Impact the Parents Club has received $178.50
as of August 30, 2021

Parents Club Membership Form 2021-2022

Payment Method*
- Pay now via Paypal/Credit Card
- Pay via check
Name(s)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Phone
Email*
Email
Your Student's Full Name:*
Pick the student's class year:*
- Class of 2025 (Incoming Freshman M1)
- Class of 2024 (Current M2)
- Class of 2023 (Current M3)
- Class of 2022 (Current M4)
Membership*
- Annual Membership - $50.00
- Annually for the "ONE HUNDRED CLUB" - $100.00
- One-time discounted contribution for the "FOUR HUNDRED CLUB" - $300
Would you like to set up recurring payments on your membership?*
- Yes
- No, only charge me once.
How many years/payments? 1-3*
You will be billed once today plus however many more payments you select yearly.
Other Contribution in the amount of:
- I would consider serving on the Parents Club Board of Directors.
- I would be interested in serving on a Parents Club Committee:
Check all that apply
- Annual Fundraising Event
- Freshman Family Day Event
- Corporate Gifts and Sponsorship
- Publicity
- Wherever I am needed most
Total
$0.00
Make checks payable to:

Parents Club/College of Medicine

Please fill out and PRINT this page and mail it and the membership dues to:

Parents Club/UAMS College of Medicine P.O. Box 250226, Hillcrest Station Little Rock, AR 72205
Annual Membership Charge
$0.00
One-Time Charge
$0.00
One-Time Charge
$0.00
CAPTCHA

Contact UAMS
Parents Club

uamsparentsclubpresident@gmail.com

P.O. Box 250226, Hillcrest Station,
Little Rock, AR 72205