UBAA New Grad Membership Application

First Name

Last Name

When is your birthday?

Your Email Address Enter your email address to access your membership online.

Your Mobile Number Please provide your mobile number so you can receive notifications regarding your account.

ENTER A PASSWORD TO ACCESS YOUR ACCOUNT

Address

Address 2

City

State

Zip Code

Country

Are you a UCLA Alumni?Yes
No

Are you a UCLA donor?Yes
No

UCLA DegreeBA/BS
Masters
Ph.D.
J.D.
M.D.
D.D.S. Check all that apply

Major

Graduation Year

Chapter

Occupation

Are you interested in volunteering opportunities?Yes
No

Are you interested in mentorship opportunities?Yes
No

Upload Photo Your photo will be added to your digital ID card to gain access.

Email Opt-InI would like to Opt In to receive e-mail messages from UCLA Black Alumni Association

Payment

Select Payment Type:Credit Card Select which payment method you'd like to use.
Bank Account TypeChecking
Savings
Name on Bank Account
Bank Name
Routing Number
Account Number
Name on Credit Card
Credit Card Number Your credit card will be tokenized and encrypted for future payments
Expiration Month Select Month
Expiration Year Select Year
Billing Address
Billing City
Billing State/Province
Billing Zip Code
Billing Country

Your credit card will not be charged until after the 3rd year from the year that you graduated.

By registering you agree to the terms and conditions set forth by UCLA Black Alumni Association. This membership is assigned to the person stated on the front of the card and can not be transferred. We reserve the right to revoke this membership if you abuse its privileges.

UBAA New Grad Membership Application

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