BFSA 2022-2023 Membership Application

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The Black Faculty/Staff Association (BFSA) is a self-supporting organization which relies on annual dues paid by members and the contributions of others who support the mission of the organization. To present quality programs, support students, and to accomplish the goals of the organization, funds are needed. Checks should be made payable to: UMSL Black Faculty/Staff Association and mailed to: Sherry Hieken, BFSA Treasurer, 204 Woods Hall.

Today's Date *

YYYY

Name *

Department *

Campus Address *

Campus Extension *

Email Address *

Select your membership fee based on your annual salary: *

$10 - $0-$34,999

$15 - $35,000-$49,990

$20 - $50,000-$74,999

$30 - > $75,000

I do not wish to become a member at this time, but I would like to make a donation to the BFSA.

I do not wish to become a member at this time, but I would like to make a donation to support student awards and scholarships.

I do not wish to become a member or make a contribution at this time, but will support the organization in another way.

If you would like to simply make a donation to the BFSA, indicate the amount.

Payment options: 1) Send your check, payable to UMSL BFSA, to Sherry Hieken, BFSA Treasurer, 204 Woods Hall; 2) Click on the first link below to complete a payroll deduction form; 3) Click on second link below to pay by credit card today.

https://umsldata.imodules.com/s/260/images/gid35/editor_documents/payroll_deduction_form.pdf?sessionid=01142bee-d9d5-4c25-8e52-25f5f9d64228&cc=1

https://giving.umsl.edu/BFSAgiving

Black Faculty and Staff Association

“Progress through Diversity”

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