Blue Key | Honorary Member Form

Student Membership Form

Individual Petition—Student Membership
Please fill in the following form & email a current photo of yourself to Janet Lance

Full Name
	First name
	Middle name
	Last name
Local Contact Information
	Street
	City
	State
	Zip
	Telephone Numer
	Email Address
Permanent Contact Information
	Street
	City
	State
	Zip
	Telephone Numer
Background Information
	Name of College/University
	Major:
	Expected Graduation Date:
	GPA:
	Professon or Business being pursued:
	Scholastic Accomplishments, Scholarships, Awards & Academic Honors:
	Organizational Memberships and Leadership Roles: (honors, professional, government, social, athletic, etc)
	Community Service, Special Activities, Special Events:

Janet Lance
Administrative Specialist
Office of the President
jholcomb@uga.edu
tel: 706-542-0017
fax: 706-542-0995

Website design: Office of Public Affairs