Spirit Wall Form

Contact Information

Tell Us About Yourself

First Name:

Last Name:

Email:

Phone Number:

Address:

City:

State

Zip Code:

Country

Are you a UCI Alumni?

YesNo

Are you a UCIAA Life Member or Chancellor's Club member?

YesNo

My Time at UCI

Preferred Class Year:

Preferred School:

Major:

Student ID:

Where to Find Me

Preferred Address:

HomeBusiness

Address:

State

City:

Zip Code:

Country

Your Choices.....

Alumni Plaque

(Only available to UCI Alumni)

$500.00 Each

Quantity:

Your Plaque Inscription
22 Characters per line, including spaces

Line 1 Personalization:

Line 2 Personalization:

Your plaque is considered a charitable contribution.

Not a Member? Join Today!

UCI Spirit Package

Open to UCI alumni and friends. Includes Life Membership to the UCI Alumni Association and a member plaque ($1,000 value).

Spirit Package:

$800.00 Each

Quantity:

Your Plaque Inscription
22 Characters per line, including spaces

Line 1 Personalization:

Line 2 Personalization:

Line 3 Personalization:

Line 4 Personalization:

The value of Life Membership is $500; remaining $300 is considered a charitable contribution..

Billing Information

First Name:

Last Name:

Email:

Phone Number:

Address:

City:

State

Zip Code:

Country

Credit Card Information:

CC Type:

PersonalBusiness

Business Name:

Credit Card Number:

Credit Card Number

CC Exp Date:

CVV:

Cybersource_Hidden_Fields

SPIRIT WALL FORM

SPIRIT WALL FORM

ABOUT UCIAA

ABOUT UCIAA

PEOPLE

WE ARE SOCIAL