Thank you for becoming a Member of the Quick Center! 
Please proceed below to select your Membership Level. 

For questions, please call (203) 254-4010 
or e-mail membership@quickcenter.com

My/my spouse's employer will match my gift

Employer Name:

How does the Matching Gift program work? Please call the Quick Center Box Office at 203-254-4010 for more information.

Member Information:

Salutation Mr. Ms. Mrs. Dr. Prof. Sr. Sir Msgr. Master Deacon Attorney The Rev. Dr. Fr. Rev.

First Name*

Middle Name

Donor Maiden Name

Last Name*

Donor Suffix

Spouse's Name (if applicable):

I/we wish to be listed in the Quick Center Program Book as:*

Help us celebrate your birthday by sharing your birthdate!

Month 1 2 3 4 5 6 7 8 9 10 11 12

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Affiliation with Fairfield University Alumnus/a Faculty/Staff Parent Retiree Friend

If you are an alumnus/a or parent, please indicate your/your child's class year 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Member Address

Street Address*

City*

State* UNITED STATES Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CANADA Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Country

Postal Code*

Preferred Email Address*

Confirm Email*

Business Phone*

Other Phone

Payment Info

Please check your information carefully for accuracy before continuing with your order.