Unity Membership Form

UNITY IN THE COMMUNITY
– Membership Form –

Advancing Cross-Cultural Understanding, Cultural Diversity
and Basic Human Rights in our Communities

APPLICATION FOR MEMBERSHIP

                                 Title:
                   First name*:
  Middle initial or name:
                   Last name*:
                               Suffix:

                                            Preferred address   When providing multiple addresses please indicate your preferred address.
                        Address*:

                                City*:      State*:      Zip code*:
                                             *Required data

                             E-mail:
                             Most communication from Unity in the Community is by e-mail.
                             If you want to receive meeting notices and other announcements please provide your e-mail address.

                             Phone:     Type:     Please identify the phone service type.
                             Phone:     Type:
                             Phone:     Type:

                                            Preferred address
      Organization name:

                         Address:

                                  City:       State:      Zip code:


                             E-mail:
                             Most communication from Unity in the Community is by e-mail.
                             If you want to receive meeting notices and other announcements please provide your e-mail address.

                             Phone:     Type:     Please identify the phone service type.
                             Phone:     Type:
                             Phone:     Type:

  Volunteer activities – please mark all that apply:
    Educational initiatives    Public event planning    Interfaith programs    Legislative initiatives
    Mentoring programs       Public forums                 Victim response – support teams
    Other:

  Select the membership class you prefer.
   Personal ($25)*    Student  ($10)*    Senior ($10)*    Family  ($35)
           *Our bylaws provide membership privileges in exchange for volunteer service and activities.
   Institutional ($50 Minimum)   Institutional members should designate a participating representative.
           –  Religious organizations, please contact our officers to request our mailings and notices. –

Mail membership checks made payable to:
UNITY IN THE COMMUNITY, Inc. P.O. Box 4292, Manassas, VA 20108-4292

	UNITY IN THE COMMUNITY – EXECUTIVE COMMITTEE
Unity in the Community P.O. Box 4292 Manassas, VA 20108	Chairperson Dexter Fox 703-368-5225 dfox@unityitc.org	Vice Chairperson Fr. Bob Menard, O.F.M. 703-221-4044 FrBob@unityitc.org	Secretary Recorder Olga Garcia Harper 703-968-7295 ogharper@unityitc.org	Treasurer Gregg Reynolds 703-494-8566 greynolds@unityitc.org
© 2007, Unity in the Community