Register to Join

2011-2012 Parents Committee

You are applying to join the U.Va. Parents Committee for the 2011-2012 term. Please provide your family's contact information below, and click submit to confirm your donation pledge.

Step 1: Full Name(s) and Home Address

Primary Contact: *

(Please include nicknames in parentheses)

Spouse/Parent:

(Please include nicknames in parentheses)

Home Address

For international addresses, please select the country you are from before selecting state. For international addresses without a postal code, please enter in 00000.

Street: *

City: *

State/Province: *

Postal code: *

Country: *

Telephone: *

For international telephone numbers do not enter in country code.

Fax:

For international telephone numbers do not enter in country code.

Email Address: *

Step 2: Primary's Business

Primary's Business Location

For international addresses, please select the country you are from before selecting state. For international addresses without a postal code, please enter in 00000.

Location name:

e.g. a place of business, venue, meeting point

Street:

Additional:

City:

State/Province:

Postal code:

Country:

Telephone:

For international telephone numbers do not enter in country code.

Fax:

For international telephone numbers do not enter in country code.

Email Address:

Step 3: Spouse's Business

Spouse's Business Location

For international addresses, please select the country you are from before selecting state. For international addresses without a postal code, please enter in 00000.

Location name:

e.g. a place of business, venue, meeting point

Street:

Additional:

City:

State/Province:

Postal code:

Country:

Telephone:

For international telephone numbers do not enter in country code.

Fax:

For international telephone numbers do not enter in country code.

Email Address:

Step 4: Children & Alumni

Please list all children: U.Va. students, U.Va. alumni and others. Include nicknames in parentheses.

Student/Family Alumnus:		Order

Suggested Information:
Full Name | U.Va. School/Class | High School/Other/Class

Step 5: Your Pledge

Intent To Join: *

I / We want to serve on the Parents Committee

Donation Pledge: *

I / We pledge to donate a minimum of $2,500

I / We prefer Parents Committee mail be sent to: *

Home Address

Primary Contact's Business

Spouse's Business

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