UPAC Membership Application |
(PLEASE PRINT) NAME____________________________________________________________ ORGANIZATION (if applicable): _______________________________________ ADDRESS: _______________________________________________________ ________________________________________________________________ CITY: ____________________________________________________________ STATE: _____________________________ ZIP: _______________________ PHONE NO.(__________)____________________________________________ FAX.(__________)__________________________________________________ Email_____________________________________________________________ DESIRED STATUS: Professional
______ $25.00
Student ______ $12.50 Associate ______
$12.50 Affiliate ______
$12.50 Subscriber
______ $12.50 IS THIS A RENEWAL? YES
________, Specify year to apply dues ______________ Would you be willing to serve in a
volunteer capacity, as a UPAC officer, member of a committee, advisor
or assistant to a USAS Chapter? |
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