Former University of Tennessee Institute of Agriculture Workers Association

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I want to become a member of the Former University of Tennessee Institute of Agriculture Workers' Association (FUTIAWA).Please include a check payable to FUTIAWA in the amount of $____________ for payment of dues. Membership dues are $3.00 annually for an individual membership or $30.00 for a lifetime membership.

Name

Address

City

State

Zip

Phone (include area code)

E-mail address

I worked at:

Ag College Experiment Station Extension College of Vet Med

Last UTIA Employment Title:

Department/Location:

Please print form and mail (with enclosed dues) to:
     Alma R. Pike
     FUTIAWA Secretary-Treasurer
     157 Country Walk Drive
   Powell, TN 37849

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