Membership Application

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MEMBERSHIP APPLICATION

If you are interested in becoming a member of the Universal Empowerment Association. Please fill out the form below, click apply and we will get back to you shortly. Please note that all information is secure and can only be viewed and accessed by a UEMPA Administrator.

Membership Application

First name

Last name

Email

Phone

Birthday

Street Address

City

Region/State/Province

Postal / Zip code

Country

How did you hear about us? * Required

UEMPA DIRECTOR

Social Media/internet

UEMPA MEMBER

OTHER

MEMBERSHIP PRIVILEGES DESIRED * Required

ADULT MALE

ADULT FEMALE

YOUNG ADULT MALE (18-20)

YOUNG ADULT FEMALE (18-20)

PLEASE STATE TWO SPECIFIC REASONS WHY YOU DESIRE MEMBERSHIP WITH UNIVERSAL EMPOWERMENT ASSOCIATION

ARE YOU INTERESTED IN A BOARD POSITION *

YES

NO

MAYBE IN THE FUTURE

ARE YOU INTERESTED IN A DIRECTOR POSITION *

YES

NO

MAYBE IN THE FUTURE

Thanks for applying! We are happy to have you as a member of UEMPA!!!

PROFESSIONALLY DESIGNED BY DR. SHANNON ALEXANDER-PHIFER| G&SP Consultants

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