Na `Opio o Ka `Aina - Hawai'i Club Member Information 2007-2008


If you have paid your dues, please fill this out so you can be marked as paid

Fields in Yellow are Required
Name:

Last:
First: (Put your nickname in "quotes")

E-mail Address (UCI email preferred):
AIM:
Birthday (MM/DD/YYYY)
   
Local Address  
Line 1:
Line 2:
City:
State: 
 ZIP :
   
Cell Phone ex:8085551234
Local Phone ex:8085551234
Permanent Phone ex:8085551234
   
Permanent Address  
Line 1:
City:
State:
ZIP:
   
Year:
Major: (Yes, all majors that UCI offers are in there!)
If other, please specify:
   

What made u want to join NOOK?

What Activities would you like to do this year? (we are always open to suggestions)

Keep my information private