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Application for Membership

Please provide the following information and submit the form. Then send your check made payable to the UTPB Alumni Association. If you prefer to mail your application, please print and send it with the check to the UTPB Alumni Program Center, 4901 E. University MB 4230, Odessa, TX 79762.


(* Required)
Name

Name while attending UTPB, if different

Degree
Major
Graduated Date

Home Address

City

State

Zip

Home Phone

Home Fax

Home Email *
Business Title/Position

Work Phone

Work Fax

Work Email *
Alumni Survey #

The Alumni Program Center is operated by the UTPB Office of Institutional Advancement through a cooperative agreement; however, membership dues are the only source of operating funds for alumni programming and are separate from gifts made to The University. For more information, call (432) 552-2809.