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Black Staff Association @ UC San Diego Membership Application
The UC San Diego Black Staff Association is a volunteer member organization. Our success is driven membership support and volunteerism. We appreciate your interest and look forward to hearing from you about your future involvement with and support of our organization.
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Email *
Date *
MM
/
DD
/
YYYY
Name *
Email (Personal or Other)
Work Phone # *
Cell Phone # (Optional)
Mail Code *
Location *
Department *
Working Title *
How long have you been employed @ UC San Diego? *
Required
Membership Type (Annually July 1st to June 30th )
New
Renewal
Annual Membership ($25) - Voting Priviledges
Friends of BSA ($10) - Non Voting
Lifetime Membership ($100) - Voting Priviledges
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I am interested in getting involved in the following ways:
Event Day Volunteer
Organizer
Mentor
Administrative Support
Staff Association Summer Celebration (Membership Drive)
Fall Kick-Off & Welcome Reception
Holiday Event(s)
Presidents' Day Forum
Black History Month
Juneteenth Celebration
Co-Sponsored Programs / Workshops
Would you be interested in purchasing merchandise with BSA logo?
Yes
No
Maybe
Face Mask
T-Shirt
Lapel Pin
Apron
Writing Pen
Ball Cap / Hat
Tote Bag
Reusable Water Bottle
Coffee Mug
Magnet
Sweatshirt
Beanie
Your comments, questions and suggestions are encouraged:
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