MEMBERSHIP APPLICATION
UAC Corporate Partnership Program 2024-25
Company/Organization
*
Company/Organization Website
*
Primary Contact
*
* Primary Person coordinating your organization’s UAC Partnership
Primary Contact Title
*
Primary Contact Phone Number
*
Please enter a valid phone number.
Primary Contact Email
*
example@example.com
Secondary Contact
Secondary Contact Title
Secondary Contact Phone Number
Please enter a valid phone number.
Secondary Contact Email
example@example.com
50 Word or Less Description of your Organization
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company/Organization Logo
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Share your logo and any marketing/advertising material you would like included in the UAC Member Directory
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of
Yes, we want to join for the Fiscal Year 2023 - 24 (please indicate amount below):
Platinum - $15,000
Gold - $10,000
Silver - $5,000
Payment Method:
Check Enclosed
Send Invoice
Credit Card (Plus Processing Fee)
Signature
Submit
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