Unitarian Universalists for Polyamory Awareness
Printable Membership / Donation Form

Updated February 2011
Office use
Date received:
Amount Received

Thank you for your interest in joining or supporting UUPA, and for your courage and generosity in taking a stand for the acceptance of polyamorous families within Unitarian Universalism. 

Included with this form are the UUPA Mission Statement and the Principles of Unitarian Universalism. By submitting a membership request you are affirming your alignment with that Mission and those Principles. Membership does not indicate anything about your own relationship choices. 

Confidential membership may be requested through use of a pseudonym. For more information about confidentiality, write to the UUPA Secretary before submitting this form, or see UUPA's Privacy Policy.

Membership dues are currently $20 in US funds per year. Additional donations are welcomed. 
This form may be used for donations, with or without membership in UUPA.

UUPA is a 501(c)(3) tax-exempt organization. Membership dues and donations are tax deductible in the US.

__New  member          __Renewal          __Donation only
Name: ______________________________________________
Preferred Name: ______________________________________
Address: ____________________________________________
Phone: ______________________________________________
Email: _______________________________________________


UUPA encourages our members to subscribe to the UUPoly email list
Are you subscribed to the UUPoly email list?   ____Yes        ____ No 

Home UU Congregation(s) Name: _____________________________________________
Congregation's City and State/Province or Country:________________________________
Congregation's UUA district:_________________________________________________
Are you a member of that 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:

___ Speaking to your congregation's minister and leadership
___ Leading programs in your congregation 
___ Contacting district or associational leadership
___ UUPA Board  of Trustees 
___ UUPA Nominating Committee 
___ UUPA Speakers Bureau 

___ Other _________________________________________________________


For statistical purposes, may we know your gender?  ___M     ___F     ___T

Year of birth? ______

As of February 2011, membership dues are $20 in US funds per year.  Dues waivers will be considered for cases of financial hardship; waivers are granted for one year at a time. Additional donations are very welcome. 


Make check payable to 
UUPA, and send to:
Dues Enclosed: 
$20US  x ___ years = $_____
___ Dues Waiver Requested for one year
18305 57TH AVE NE


___ $10
___ $50 
___ $100
___ $500
___ Other Amount $____
UUPA is a 501(c)(3) tax-exempt organization.
Membership dues and financial contributions to UUPA are tax-deductible in the US.



Membership Affirmation:  I have read the UUPA Mission Statement and the Principles of Unitarian Universalism, and I find myself to be in harmony with that Mission and those Principles.

Signature: _____________________________________________________   
Date: _________________________________________________________


UUPA  --  Mission and Principles

Mission Statement of UUPA

Unitarian Universalists for Polyamory Awareness (UUPA) has as its Mission to serve the Unitarian Universalist Association and the community of polyamorous people within and outside the UUA by providing support, promoting education, and encouraging spiritual wholeness regarding polyamory.

UUPA defines polyamory as the philosophy and practice of loving or relating intimately to more than one other person at a time with honesty and integrity. UUPA advocates for any form of relationship or family structure--whether monogamous or multi-partner--which is characterized by free and responsible choice, mutual consent of all involved, and sincere adherence to personal philosophical values.

To provide support:  for UU members and friends considering relationship choices; through networking among polyamorous identified UUs; for polyamorous-identified UU religious professionals and ministerial students; through outreach of Unitarian Universalism to the broader polyamorous community continentally;

To promote education:  to provide educational materials on polyamory for Unitarian Universalist congregations and the general public; to provide information and guidance to parents, teachers, and other child-related adults regarding the ability of polyamorous families to provide happy and healthy home lives for their children; to serve as a resource to UU religious professionals as they learn to minister to polys; to promote dialogue between polyamorous and non-polyamorous people for the purpose of improving understanding; to emphasize the importance of personal relationships and social justice; to encourage respect, honesty, consensuality, commitment, mutuality, justice, pleasure, and love in all relationships;

To encourage spiritual wholeness:  to celebrate the goodness of creation, including our bodies and our sexuality; to promote recognition that sexuality is central to our humanity and integral to our spirituality; to reconcile and integrate various multi-partner relationship choices, whether sexual or non-sexual, with theological perspectives and spiritual needs; to promote full inclusion of polyamorous identified UUs in congregational life.

Principles of Unitarian Universalism

We, the member congregations of the Unitarian Universalist Association, covenant to affirm and promote: 

The inherent dignity and worth of every person; 
Justice, equity, and compassion in human relations; 
Acceptance of one another and encouragement to spiritual growth in our congregations; 
A free and responsible search for truth and meaning; 
The right of conscience and the use of the democratic process within our congregations and in society at large; 
The goal of world community with peace, liberty, and justice for all; 
Respect for the interdependent web of all existence of which we are a part.


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