Online Membership/Donation Form

Thank you for your courage and generosity in joining or supporting UUPA

After you have filled out the following form, and clicked on the submit button, you will be directed to a page where you can pay your membership fee and/or make a donation via check or PayPal. Membership is currently $20 per year. Additional donations are welcomed.

Purpose of this submission?

 New Member Renewal Donation

Please enter your First Name:

Please enter your Middle Initial:

Please enter your Last Name:

Please enter your Preferred Name:

Please enter your Street Address or POB:

Please enter your City:

Please enter your State or Province:

Please enter your Zip code or Postal code:

Please enter your Country:

Please enter your email address:

Please enter your phone number:

May we contact you?

 Yes No

Are you subscribed to the UUPOLY email list?

 Yes No

Home UU Congregation Name:

Congregation City and State/Province or Country:

What district is your church in?

Are you a member of this UU congregation?

 Yes No

How long have you considered yourself a UU?

What offices or positions have you held in a UU congregation?

What skills or resources might you like to contribute?

Would you be willing to serve by/on


 (Select all that apply; use CTRL-click to select)

Other areas of service?

For statistical purposes, may we know your gender?

 Female Male Trans

Year of birth?
How much of your contribution should be applied to membership? 1 Year $20 2 Years $40 3 Years $60 Donation only

Are you requesting a waiver of dues for one year? Please explain below.

 Yes No

Please enter any message you wish to send us:
By submitting this form you affirm your alignment with our Mission and Principles

This form and its forms processing software supplied by www.tectite.com.

Form update Nov. 23, 2007