UNIVERSITY OF VICTORIA RETIREES ASSOCIATION

MEMBERSHIP FORM

Effective April 1, 2026, eligible retirees who join at any time during the UVRA fiscal year (April 1 to March 31) will receive a free membership for that fiscal year. They do not need to pay any fees at the time of joining, but at the end of that fiscal year, they can renew either by paying the annual membership fee or by converting to a life membership, with the applicable life membership fee.

First Name		
Last Name	 	
Street Address	 	
City		
Province	 	
Postal Code	 	
Spouse Name	 	
Phone number 	 	
Date Joined	  dd-mon-yyyy	
Date of Birth	  dd-mon-yyyy	
Group Type	__ faculty / __ staff  	
Email Address	 	
Department	 	
University 	 	
Member Status	__  Life / __ Annual 	

RECEIVED IN OFFICE: ____________              ON DATABASE: ___________
ML____Date____________________   		BY: _____________________
BK____Date_______________