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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