USI Parents & Families Membership Form

Membership Form

To pay by mail, please print and fill out this form (pdf) and return with a check ($25 minimum/individual or per family) payable to the USI Foundation. Mail check and completed form to:

USI Foundation
8600 University Boulevard
Evansville, Indiana 47712

Member Name(s):

First Name

M.I.

Last Name

First Name

M.I.

Last Name

Parents or Family of:

Date of (or expected) Graduation:

Street Address:

City, State, Zip:

City

State

Zip Code

Phone Number:

Ex. 8124615430

Email Address:

To make your annual gift ($25 minimum/ individual or per family) by credit card, please complete the following information:

Credit Card Type:
Credit Card Holder:
Billing Zip Code:
Account Number:	Ex. 0000111122223333
Expiration Date:	Ex. MMYY
CVV Number:	How to find your CVD number
Gift Amount:	$
($25.00 minimum required for membership)

Questions? Call (812) 465-1215 for assistance.

8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600