WELCOME TO THE UCLA BRUIN VARSITY CLUB - MEMBERSHIP SECTION

IF YOU FEEL YOU HAVE MET THE MEMBER QUALIFICATIONS TO BE A PART OF THE BRUIN VARSITY CLUB. PLEASE FILL OUT THE FORM BELOW SO THAT WE CAN SEND YOU ADDITIONAL INFORMATION REGARDING THE PROGRAM. THANK YOU!

First name*

Middle Initial*

Last name*

 

Maiden name (if applicable)

Spouse name (if applicable)

 
Gender*:
Male   Female
 
Mailing Address*

 

City *

State *

ZIP *

 
Preferred E-mail *

 
Daytime Phone *

 
Cell Phone

 
I participated in SPORT(S)*

 
I participated in this sport starting in* and finished participating in*
 
Date of Birth (MM/DD/YYYY)