Parents Association Membership Form

*Items marked with an asterisk () are required.**
Member information
	First Name*	Last Name*	Email*	Relationship to student:*
1
2
Address Line 1:*
Address Line 2:
City/State/Zip:*		, -
Phone Number:*		() -
Alternate Phone Number:		() -
Student information
Please list the BannerID (if known) and name of your UAB student.

Student's First Term at UAB:*
(Note: This is the term your membership will begin. If your student's first term is during the summer, please select the fall term which follows.)

UAB Undergraduate Admission

1701 11th Ave S,

Birmingham, AL 35294

Postal address: Box 99, 1720 2nd AVE S BIRMINGHAM AL 35294-4600

Phone: 1-800-421-8743 or 205-934-8221

Text Only

Birmingham, Alabama 35294