UNIVERSITY OF VICTORIA RETIREES ASSOCIATION

MEMBERSHIP FORM

Effective April 1, 2026 eligible retirees joining UVRA will receive a free membership for the remainder of UVRA’s fiscal year, which is April 1 to March 31. They will then have the option of continuing their UVRA membership by paying the annual, or the lifetime, 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_______________