Best Card Online Payments

To establish or renew your membership with the University of Washington Dental Alumni Association, fill out the following form:

Type of Member *

Alumni Members $120 (UW DDS/MSD/Certificate Graduate/UW Hygiene Graduate)

Recent Alumni Members $50 (5 years or less since graduation)

Associate Members $120 (Non-UW Dentistry Alumni)

Cardholder first name *

Cardholder last name *

Member Name *

Company

Billing Address *

Billing City *

Billing State/Province

Billing State *

Billing Zip *

Phone number

Email *

Year of Graduation (enter N/A if not applicable) *

Automatically renew every year on October 1st? (YES/NO)

Payment amount *

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