Online Membership/Donation Form

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

After you fill out the following form and click on the submit button, you will be directed to a page where you can pay your membership dues and/or make a donation via check or PayPal.

Membership dues are currently $20 per year. Additional donations are welcome.

Dues and donations support UUPA's mission of support, education, and spiritual encouragement. For example, a booth in the General Assembly Exhibit Hall, informational literature,  and ads in the UU World magazine.

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Purpose of this submission?

*  New Member   Renewal   Donation
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First Name:

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Middle Initial:

 
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Last Name:

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Preferred Name:

 
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Street Address or PO Box:

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Street Address 2nd line

 
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City:

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State or Province:

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Zip code or Postal code:

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Country:

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email address:

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phone number:

 
 

May we contact you?

  Yes No
 

Are you subscribed to the UU Polyamory email list?

  Yes No
 

Home UU Congregation Name:

 
 

Congregation City and State/Province or Country:

 
 

In which district or region is your congregation located?

 
 

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?

 
 

How did you hear about UUPA?

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

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:

 
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Form update Mar. 2, 2015