Registration Form

Please:  1. Print this page   2. Complete the form   3. Enclose the form + your check (unless using a credit card) and mail to:

California State University, Los Angeles
College of Engineering, Computer Science, and Technology
5151 State University Drive
Los Angeles, CA   90032-8150

Yes! I/we would like to become a member of Friends of Engineering, Computer Science, and Technology (FECST) at California State University, Los Angeles.  I/we have enclosed a contribution for the current academic year and have checked the appropriate category below.  I/we understand that contributions are tax deductible and will be used to support Engineering, Computer Science, and Technology programs at CSULA.
___  Friend of ECST ($100)

___ Sustaining Member ($150)

___ Patron ($200)

___ Sponsor ($300)

___ Benefactor ($500)

___ Distinguished Benefactor ($1,000 or more)

___ I have enclosed a check for $____________ made payable to Friends of ECST.

___ You may charge this donation to my   ___Mastercard   ___Visa account.

Card#________________________________ Exp. Date________________________

Please print your name(s) exactly as you wish it to
appear on the Friends of Engineering, Computer Science, and Technology roster.


Street Address__________________________________________________________

City___________________________________  State_____  Zip Code_____________

Telephone (____) __________________  Email address:_________________________

If your employer supports matching gifts, please list your company name below:


Thank You!