Unitarian Universalists for Polyamory Awareness
Printable Membership / Donation Form

Updated March 9, 2018

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.  Confidential membership may be requested through use of a pseudonym. Membership dues are currently $20 in US funds per year. Additional donations are welcomed.  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.
Have you subscribed?   ____Yes        ____ No 
Home UU Congregation(s) Name: _____________________________________________
Congregation's City and State/Province or Country:_________________________________
Congregation's UUA Region:__________________________________________________
Are you a member of that congregation?    Yes ______  How long?______
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 Speakers Bureau  ___ Other ______________________
For statistical purposes, may we know your gender?  ___M   ___F   ___Other
Year of birth? ______

Membership Affirmation: I have read the UUPA Mission Statement and the Principles of Unitarian Universalism, and I find myself to be in harmony with them.
Signature: _____________________________________ Date: ________