UNIA-ACL APPLICATION – UNIVERSAL NEGRO IMPROVEMENT ASSOCIATION – AFRICAN COMMUNITIES LEAGUE

UNIA-ACL APPLICATION

There are two types of members. GARVEYITE MEMBERS: These members are paying dues members! Non paying dues members: Every black/ person of african decent is a member. To be a dues paying member (GARVEYITE) the dues will be Monthly Initial fee of $14.50 and then $4.50 per month. or YEARLY FEE which is $56.00 for your first year and $46 every year after.

Name

First Last

Gender

MALE

FEMALE

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Cell Phone

Home Phone

Date of Birth

Height

Weight

Hair Color

Eye Color

Spiritual Affiliation

EMERGENCY CONTACT

First Last

Emergency contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Cell Phone

Emergency contact Alternate Phone

Why do you want to join the UNIA-ACL

What skills do you have that will benefit the BLACK RACE?

Please select at least one committee

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