Parents and Family Association Gold Membership Form

Fields with a ( * ) are required.

Personal Information
* First Name:
* Last Name:
* Phone Number:
* EMail:
* Street Address:
* City:
* State:
* Zip Code:
* Country:
* Relationship to student:
Additional Parent/Spouse/Guardian Information
First Name:
Last Name:
Phone Number:
EMail:
Street Address:
City:
State:
Zip Code:
Country:
Relationship to Student:
Student Information
* First Name:
* Last Name:
WIU ID Number:
* Date of Birth:
Additional Student Information
First Name:
Last Name:
WIU ID Number:
Date of Birth: (MM/DD/YYYY)
Membership Information

Benefits

Gold members receive all the benefits of PFA plus…

  • In-depth newsletters via email two to three times a semester
  • First release of the Union Hotel rooms for Dads' Day and Moms' Day
  • Scholarship opportunities
  • A WIU gift, which can be picked up by parent or student in the PFA office (located in the Student Development Office, University Union, First Floor). Gifts cannot be mailed.
  • PFA Gold Membership lasts 12 months from registration submission.
* Membership Amount:
$
.00
* Membership Option:
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