UUSCM Membership Application
Title *
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First Name *
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Last Name *
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Degree, Certification, License
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Organization/Company
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Street Address *
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Town/City *
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State/Province *
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Zip/Postal Code *
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Work Phone
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Home Phone
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Cell/Mobile Phone
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eMail Address *
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I Am Joining UUSCM as a... *
Theological School/Seminary (if a student)
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Name of UU Congregation I'm affiliated with
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Fellowshipping Status
Ordination Status
Detailed Description of My Ministry *
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Name of Personal/Professional Reference *
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Email of Personal/Professional Reference *
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Name of My Parish Minister *
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Email of My Parish Minister *
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