LIFE Society Membership

New Members

Please contact Marion McCarty at (951) 827-4102 or e-mail MarionM@ucx.ucr.edu.

Current Members

• $110 per year (July 1 to June 30)
  Includes parking permit which will be mailed with September newsletter.

Print this page and fill out the information below.

Full Name (please print):

Home Address (street, apt. no.):

City, State and ZIP + 4:

Social Security No. (optional):

Daytime Phone:

E-mail Address:

Enclose:
Check made payable to REGENTS-UC in the amount of $_______ to cover _______ membership(s) along with this completed form.

OR to use your credit card:

VISA/MasterCard No.:

Exp. Date:

Authorizing Signature:

Mail to:
UCR Extension
Attn: Marion McCarty
1200 University Ave.
Riverside, CA 92507-4596