1 Start 2 Complete Name: Home Address: Home Phone: Cell Phone: May we call or text on this number? Call Text Both Neither Email: Secondary Email: Would you like secondary email included on all UWNEK emails? Yes No Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Wedding Anniversary: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Business Name: Business Address: Business Phone: Other than your current employer, what other businesses do you have connections with that might be beneficial to UW campaigns? What committees would you like to serve on? Campaign Event Planning Community Investment Team Finance
