Name:

Title:

Academic Institution:

Preferred Address:

Cell: Office: Home:

Email:

Membership Fee:

Check No.

* Please send all checks to Veranda on Highland - 2220 Highland Avenue South - Birmingham, AL 35205 or stop by at anytime to drop the check off.

* We accept all major credit cards at the restaurant. You can come by anytime with a printed copy of your application.

Any Suggestions for services or events that you would like to see instituted by the University Club?

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