UIA Gift of Membership Application
Membership applications require UIA Board approval and are reviewed monthly.
Your Information
First Name: *
Last Name: *
Phone: *
Email:
Are you a member of the Ukrainian Institute of America? *
Please choose your payment plan for the gift *
Membership - Initiation Fee is tax deductible. Tax Identification number: 13-1832391
Gift Recipient Information
First Name: *
Middle Name:
Last Name: *
Date of Birth: *
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Place of Birth:
Citizenship:
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