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Pride and Equity Faculty Staff Association
Membership Form

Thank you for joining PEFSA and helping to make history!


Once you have completed your online membership form, please click the [Send This Form] button below and you will be directed to our payment page where you can select the membership level of your choice and make an easy online dues payment.

Member Information

Name:  

Email Address:  
 
Phone Number: (xxx-xxx-xxxx)  
 
College/School/Area:  

Department:  
 
Job Title:  

Position: 
 

PEFSA Membership Options
Please select one of the membership options from the list below.

Bronze Membership ($15) –

Silver Membership ($30) – Basic PEFSA membership plus $15 in support of our programming and goals. PEFSA thanks you for your extra contribution with a PEFSA mug.

Gold Membership ($60) –Basic PEFSA membership plus $45 in support of our programming and goals. PEFSA thanks you for your extra contribution with recognition (optional, see below) of your contribution on the PEFSA website honored supporters list and a PEFSA mug!

Lifetime Platinum Membership ($100) – Lifetime PEFSA membership. PEFSA thanks you for your commitment to lifetime membership with recognition (optional, see below) of your contribution on the PEFSA website honored supporters list and a PEFSA mug!

Please check here if you prefer your extra contribution to be anonymous.

 

Please select the committees in which you would like to be a valued member.

     

21 November 2012
UT PEFSA