|
|
Membership Application |
|
return it with your UWRA membership dues check to: United Way Retirees Association United Way of America 701 Fairfax Street Alexandria, VA 22314 Please Print Name:_________________________________ Address:_______________________________ ______________________________________ City:__________________________________ State:_________________ Zip:____________ Telephone: (_____) ______________________ Fax: (_____) ___________________________ E-mail: ________________________________ Nickname: _____________________________ Spouse's Name: ________________________ Check The Appropriate Box:
Check One:
|
Retiree's Name: ___________________
Date of Retirement: ________________ Name of Last United Way Served ________________________________ City: ______________ State:_______
OPTIONAL
_______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ |