UCCA Membership Form

To become a member of the UCCA today, please fill out the membership form below. Annual dues are in the amount of $50 for general membership or $30 for senior citizens and students.

The UCCA is a 501(c)3 non-profit organization and all donations including membership dues are tax deductible.

To join the UCCA you can:

• fill out this form, submiting your annual dues by credit card (thanks to the generosity of Helping.org) in the amount of $50 for general membership or $30 for senior citizens and students

• print out a printable application and send it and your donation in by US mail

• request a membership application be sent to you by US mail

For more information please contact donate@ucca.org or call the National Office at (212) 228-6840

More ways you can support the UCCA

First Name*:        Last Name*: 

Mailing Address*: 

Mailing Address Line 2:(optional) 

City*:     State*:  Select One Alabama Alaska Am. Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other 

Zip*: 

Country:  

Daytime Phone:     FAX:    

Evening Phone:     
(Please use format 111-111-1111)
E-mail address":     Example: kozak@ucca.org

Year Of Birth: 
(Please use format 2XXX)

Profession: 

For More information, please contact: donate@ucca.org
©2000 Ukrainian Congress Committee of America, Inc