2024 MEMBERSHIP RENEWAL
or APPLICATION TO TRANSFER TO PERMANENT (LIFE) MEMBERSHIP

Name: _______________________________________________ DOB: ______/______/______ 	
									     DD/mon/YYYY
☐ Annual Membership - $30.00
☐ Two-Year Membership - $55.00
☐ Three-Year Membership - $80.00
☐ Transfer to Permanent (Life) Membership – see below (contact office if unsure)
Number of Years Annual Membership Paid	Fee to Convert to Permanent (Life) Membership	
10 or more years	$ 38	
9 years	$ 49	
8 years	$ 60	
7 years	$ 71	
6 years	$ 82	
5 years	$ 93	
4 years	$ 104	
3 years	$ 115	
2 years	$ 130	
1 year	$ 145	

Changes to personal information (if any):

Address: _______________________________________________________________________

City: _________________________________	Postal Code: ____________________________

Telephone: _______________________Email: ________________________________________

Signature: ____________________________________________Date: _____________________

For payment, we accept INTERAC e-transfer. If you select this option, note that UVRA has arranged with the bank to have Interac e-transfers deposited directly into UVRA’s bank account, so you will be asked, on the e-transfer page, to give our email address (uvra@uvic.ca) and accept this arrangement.

If you prefer to pay by cheque, please make your cheque payable to UVic Retirees Association, and mail it to:
UVic Retirees Association, University of Victoria, PO Box 1700 STN CSC, Victoria BC, V8W 2Y2.

NOTE: The office is usually staffed Mondays, Wednesdays, and Fridays from 10:00am to 2:00pm, September to June. If you wish to visit the office (Room #125/R-Hut), please email us first (uvra@uvic.ca) to ensure there will be someone there to welcome you.  Thank you. 

FOR OFFICE USE: 			Amount	Database updated on: 
Date received						By: