UNA-USA logo Membership Form for the UNA-USA McLean County Chapter

Member   Spouse/Other
Title:   Title:
First Name:   First Name:
Last Name:   Last Name:

 

 

 

 

Street 1:
Street 2:
City:
State:
Email Address:
Home Phone: Work Phone:
I am: A new member
Renewing my membership

Membership Categories:

$1,000 Lifetime Membership, a one time payment.
$500 Patron
$100 Sponsor
$40 Member
$25 Introductory, first year only
$25 Fixed Income
$10 Student

In addition to my membership dues, I would like to make a contribution to the McLean County UNA-USA of $

Please mail this form with a check payable to the McLean County UNA-USA, ATTN: Membership, P.O. Box 1901, Bloomington, Illinois 61702.