UUCA-CUUPS Individual Registration


Name:  ________________________________   AKA.:  _______________

Address:  _____________________________________________________

Phone:  ____________________   Alt. Phone(s):  ____________________

E-mail:  _____________________   Member of CUUPS International?  ____

If you will, describe your past and/or current involvement/participation with 

Earth-based spirituality:  _________________________________________

_____________________________________________________________

_____________________________________________________________

What are your current interests?  What topics would you like to study and 

what activities would you like to take part in?  _______________________

_____________________________________________________________

_____________________________________________________________


What skills and knowledge can you share with the group?  ______________

_____________________________________________________________

_____________________________________________________________

Overall, what would you like to get out of being a member of UUCA-CUUPS?

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________
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Membership Dues Record

________________   $_________          ________________   $_________

________________   $_________          ________________   $_________

________________   $_________          ________________   $_________