UUCA-CUUPS Family Registration Names of Family Members: AKA: DOB(children's) E-mail: _______________________________ _________________ ___________ ___________________________ _______________________________ _________________ ___________ ___________________________ _______________________________ _________________ ___________ ___________________________ _______________________________ _________________ ___________ ___________________________ _______________________________ _________________ ___________ ___________________________ _______________________________ _________________ ___________ ___________________________ Address: _____________________________________________________ Phone: ________________________ Alt. Phone(s): ________________________________ CUUPS International Members? Family Individual(s) None . (please check in front of names above of individuals with membership) ________________________________ If you will, describe past and/or current involvement/participation of family members with Earth-based spirituality: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ What are current interests of family members? What topics would they like to study and what activities would they like to take part in? _____________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ What skills and knowledge can family members share with the group? _____________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Overall, what would your family like to get out of being members of UUCA-CUUPS? ___________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------ Membership Dues Record ________________ $_________ ________________ $_________ ________________ $_________ ________________ $_________ ________________ $_________ ________________ $_________