UCWHA MEMBERSHIP APPLICATION

 

 

 

Membership Costs:  Individual - $15.00 (Any individual over 18 or not covered

in family membership)

 

                                  Family -     $20.00 (Includes husband, wife and children under 18, does not include grandchildren)

 

 

Please include the following information with your dues:

 

 

Name___________________________________________________

 

Children_________________________________________________

 

          ___________________________________________________

 

Address__________________________________________________

 

City & State, Zip___________________________________________

 

Telephone:  Home ____________________Work_________________

 

Email address_____________________________________________

 

Type of Membership:        Individual

 

                                      Family    

                    

 

Print and fill out application, and mail with membership fee (make checks payable to UCWHA)  Mail to:       UCWHA

                                           P. O. Box 2645                             __________________

                                           Cookeville, TN   38502                Membership Year