Membership Form

Please provide the following contact information:

 Name  
 Street address  
 Address (cont.)  
 City   
State/Province  
 Zip/Postal code  
 Country  
 Work Phone  
 Home Phone  
 E-mail  

 

Yes, I (we) would like to become a member:

Introductory - $25 per person or family

 

In addition to my membership dues, I would like to make a contribution:

Contribution: $_________

Free Materials:

Membership includes free copies of the Iowa UNA publications. Indicate which of the following you would like to receive.

Taking on the Challenge of Climate Change
A Social Agenda for Iowa for the 21st Century
The Iowa Declaration
Earth Charter and Agenda 21 for Iowa

Please print and return this form and send it along with your check, payable to Iowa Division UNA-USA

Iowa Division UNA-USA
20 East Market Street
Iowa City, IA 52245

For further information contact:

Iowa UNA
Phone: 319-337-7290
Email: unaiowa@unaiowa.org