RENEWAL OF ANNUAL MEMBERSHIP -- APRIL 1, 2023, to March 31, 2024 
or APPLICATION TO TRANSFER TO PERMANENT (LIFE) MEMBERSHIP

Name: _______________________________________________	
									     
☐ Renew Annual Membership - $20.00. Present form can be filled online and emailed back to UVRA.
☐ 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	  $64	
9 years	  $76	
8 years	  $83	
7 years	  $93	
6 years	$102	
5 years	$112	
4 years	$122	
3 years	$128	
2 years	$131	
1 year	$144	

Changes to personal information (if any):

Address: _______________________________________________________________________

City: _________________________________	Postal Code: ____________________________

Telephone: _______________________Email: ________________________________________

Signature: ____________________________________________Date: _____________________

If you do online banking, we accept INTERAC e-transfer. If you select this option, receiver’s name is UVRA and email address is uvra@uvic.ca . UVRA has automatic acceptance, so no Q&A. If you want 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: If you want to pay in person, please email uvra@uvic.ca before coming to ensure there will be someone in the office to greet you.

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