WELCOME TO THE UCLA BRUIN VARSITY CLUB - MEMBERSHIP SECTION

IF YOU FEEL YOU HAVE MET THE MEMBER QUALIFICATIONS TO BE A PART OF THE BRUIN VARSITY CLUB. PLEASE FILL OUT THE FORM BELOW SO THAT WE CAN SEND YOU ADDITIONAL INFORMATION REGARDING THE PROGRAM. THANK YOU!

First name*
Middle Initial*
Last name*

 
Maiden name (if applicable)
Spouse name (if applicable)
 
Gender*:
Male   Female
 
Mailing Address*

 
City *
 State *
ZIP *

 
Preferred E-mail *

 
Daytime Phone *

 
Evening Phone

 
Cell Phone

 
Fax

 
I participated in SPORT(S)*

 
I participated in this sport starting in* and finished participating in*
 
Employer and Job Title

 
Date of Birth (MM/DD/YYYY)

 
I am interested in becoming a PREMIER member     
I would like to receive my (FREE) ACTIVE Bruin Varsity Club membership card     
Yes, I would like to make my information available exclusively to other Bruin Varsity Club members     
 
 

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