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MEMBERSHIP APPLICATION

Please complete this application and submit online or print it and mail with payment to:

UCBC P.O. Box 24492 Edina, MN, USA 55424-0492

Type of Membership:	Individual($200) Corporate($500)Student($25 – Waived during 2008)
	Membership rate is prorated by quarter
First Name	*	UCBC MEMBERSHIP BRINGS SIGNIFICANT BENEFITS Free admission to monthly breakfasts for one year Discounted prices at special events and seminars Access to “Members Only” information on UCBC Website Company profile on UCBC “Members Only” website Monthly newsletter packed with business news
Last Name	*
Title
Company Name
Address 1	*
Address 2
City	*
State	*
Zip Code	*
E-mail Address	*
Confirm E-mail Address	*
Telephone	*
Business Description
Please select a login name and password for yourself, you will need it to access member only pages in the future:
Login Name:	*
Password:	*
Confirm Password:	*