UUSCM Membership Application
Title *
First Name *
Last Name *
Degree, Certification, License
Organization/Company
Street Address *
Town/City *
State/Province *
Zip/Postal Code *
Work Phone
Home Phone
Cell/Mobile Phone
eMail Address *
I Am Joining UUSCM as a... *
Theological School/Seminary (if a student)
Name of UU Congregation I'm affiliated with *
Fellowshipping Status
Ordination Status *
Name and location of ordaining body and date of ordination (if not ordained, "NA") *
Detailed Description of My Ministry *
Name of Personal/Professional Reference *
Email of Personal/Professional Reference *
Name of My Parish Minister *
Email of My Parish Minister *
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