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Membership Application Form
*
Required
Name
*
Date of Birth
*
Phone Number
*
Cell Number
Email
*
Occupation
*
Address
*
*
*
*
*
Are you interested in volunteering?
*
Yes**
No
**If Yes, please check your area(s) of interest.
Events
Food & Beverage
Sports
Arts & Culture
Media
Languages
Children
Music
Ukrainian History
Office Work
Other**
**If "other", please specify
Spouse Information (if joint membership)
Name
Date of Birth
Phone Number
Cell Number
Email
Occupation
Are you interested in volunteering?
Yes**
No
**If Yes, please check your area(s) of interest.
Events
Food & Beverage
Sports
Arts & Culture
Media
Languages
Children
Music
Ukrainian History
Office Work
Other**
**If "other", please specify
Children Under 16 Years of Age
Name
Name
Name
Name
How did you hear about us?
a friend
a UCPBA member
our website
other**
**If "other", please specify
If someone from the UCPBA has invited you to become a member, please provide their name.
Would you like your business listed on the membership page of the website?
Yes**
No
** If yes, please provide your business name or title and website or contact email to be listed on the membership page.
Business Name or Title
Website or Contact Email
Choose Membership Type
*
Regular Membership: $25.00
Regular + Spouse Membership: $40.00
Student Membership: $15.00
IMPORTANT: upon clicking "Submit and Pay", your application will be sent and you will be directed to the payment page. Please double check that all of your information is accurate and correct before submitting.
