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Get Longhorn Foundation Patron Membership Application

Red) DATE: CITY STATE PHONE(H) PHONE(O) SOCIAL SECURITY # Paid By: MC/VISA/AMEX CARD# q Donor’s Check ZIP q MC/VISA/AMEX (See authorization below) MAKE CHECKS PAYABLE TO: The University of Texas 30-6269-2493 A-1701 EXP. DATE ACC’T NAME PAYMENT AMOUNT SIGNATURE DATE OFFICE USE ONLY EMPLOYER TITLE UFCU (03A) .

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