Application for Member-at-Large (MAL) Membership

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Application for Membership (MAL)

Last Name

First Name

Date of Birth*

mm/dd/yyyy

Select Date ×

Address*

Full mailing address and City

Street Address

City

Country

State

ZIP Code

Email Address

Phone

Preferred way to be contacted*

Phone

Email + Phone

Payment

Please forward annual membership dues in the amount of $58.00 with a copy of your application to the address shown below.

UNWLA (attn: MAL registration)
203 2nd Avenue, 5th Floor
New York, NY 10003-5706

My Initials*

I have read and understand the contract.

Please type here: Full name or Initials

5 plus 3 equals?*

Prove you are a human

Write here

After you submit your application, you will be contacted by the Members-at-large (MAL) Liaison who will provide you with specific MAL information.

Your application has been submitted

Thank you %LNAME%, %FNAME% for application
A copy of your submission has been emailed to you.

Please forward annual membership dues in the amount of $58.00 with a copy of your application to the address indicated on the form.

UNWLA (attn: MAL registration)
203 2nd Avenue, 5th Floor
New York, NY 10003-5706

If you want to update or edit your application form, click on the link provided on e-mail

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