This is a Blueprint template.

Membership & Scholarship Donation Form: This form will not submit without including a new or renewal membership to the Retirees Association. To make a donation to any of the Retiree Association scholarships without processing a membership please use the scholarship form located here.

UC Santa Cruz Retirees Association

Is this a new or renewal membership? 

Is this a new or renewal membership?

New
Renewal
"Is this a new or renewal membership?" is required.

If New, it is customary for the Retirees Association to list the names of new members on our website as well as in our quarterly newsletter. May we include your name? 

If New, it is customary for the Retirees Association to list the names of new members on our website as well as in our quarterly newsletter. May we include your name?

Yes you can include my name.
No do not include my name.
"If New, it is customary for the Retirees Association to list the names of new members on our website as well as in our quarterly newsletter. May we include your name?" is required.

 

First Name: 

"First Name" is required.

Last Name: 

"Last Name" is required.

Address 1: 

"Address 1" is required.

Address 2:

City: 

"City" is required.

State: 

Please Choose Alabama Alaska Alberta American Samoa Arizona Arkansas Australian Capitol Territory British Columbia California Canal Zone Colorado Commonwealth of N Mariana Is Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Military - Americas Military - Europe Military - Pacific Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales New York Newfoundland North Carolina North Dakota Northern Mariana Islands Northwest Territory Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Queensland Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania Tennessee Texas Trust Territories Utah Vermont Victoria Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Other
"State" is required.

Zip: 

"Zip" is required.

 

Phone Area Code:

Phone Number: 

"Phone Number" is required.

Cell Phone Area

Cell Phone Number:

Email: 

Email

"E-mail" is required.

Confirm Email
"E-mail" confirmed text is required. Emails do not match! "E-mail"needs to contain a valid entry.

Your password must have

each of the above components

and be at least 12 characters.

Does Not Pass

Low

Moderate

Secure

Very Secure

Re-type your password. Re-type your email. Please verify your input by typing it again.

Passwords do not match! Emails do not match! Inputs do not match!

Passwords match! Emails match! Inputs match!

Job Title at retirement

Unit at retirement

If not a retiree from UC Santa Cruz, where did you retire from?

Retirement year

Please Choose 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

 

Membership Levels

Select membership type below:			Level
Individual Annual Membership			$15.00
Membership lasts one year from day of payment
Dual Annual Membership			$20.00
Membership lasts one year from day of payment and is for a two-person shared membership.
Individual Lifetime Membership			$150.00
Lifetime membership for a single person.
retirees - Dual Lifetime Membership			$200.00
Lifetime membership for a two-person shared membership.

"Membership Levels" is required.

retirees annual membership Banner id

CH013F

retirees lifetime membership Banner id

CH014F

 

Complete the following fields for Dual Membership.

Spouse/Partner First Name

Spouse/Partner Last Name

Spouse/Partner UC Santa Cruz Affiliation

Spouse/Partner UC Santa Cruz Affiliation

UC Santa Cruz Retiree
Current Employee
Alum
None

If spouse/ partner is a UC Santa Cruz retiree, last job title at retirement.

If spouse/ partner is a UCSC retiree what was the last unit at retirement?

Spouse/Partner retirement year

Please Choose 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Communication: All communications including Newsletters, Event/Meeting reminders and important announcements
will be sent via email* and/or can be accessed through the UCSC Retirees website. (*Those who opted for hard copy
newsletters in the past will be grandfathered in and will continue to receive hard copies).

Giving Opportunities

Silver Slug Scholarship for current or retired UCSC staff & their dependents studying at UC Santa Cruz.

For the Silver Slug Scholarship Endowment fund (SS006ENDF):

$
"For the Silver Slug Scholarship Endowment fund (SS006ENDF)" must be currency. "For the Silver Slug Scholarship Endowment fund (SS006ENDF)" must be equal to or greater than $5.00. "For the Silver Slug Scholarship Endowment fund (SS006ENDF)" is too large.

Silver Slug Scholarship

SS006ENDF

UCSC Retirees Association Bruce Lane Memorial Scholarships for military veteran students:

For awards to be given this year...Bruce Lane Scholarship (FI005F).

$
"For awards to be given this year...Bruce Lane Scholarship (FI005F)." must be currency. "For awards to be given this year...Bruce Lane Scholarship (FI005F)." must be equal to or greater than $5.00. "For awards to be given this year...Bruce Lane Scholarship (FI005F)." is too large.

Bruce Lane Scholarship (FI005F)

FI005F

For long term support... the Bruce Lane Scholarship Endowment fund (CH007ENDF):

$
"For long term support... the Bruce Lane Scholarship Endowment fund (CH007ENDF)" must be currency. "For long term support... the Bruce Lane Scholarship Endowment fund (CH007ENDF)" must be equal to or greater than $5.00. "For long term support... the Bruce Lane Scholarship Endowment fund (CH007ENDF)" is too large.

Bruce Lane Endowment (CH007ENDF)

CH007ENDF

Please Wait...