United States Catholic Mission Association

Friday, May 16, 2008

ORGANIZATIONAL - NEW MEMBERSHIP

Please Note:
Each organization must provide the name of a contact person, AND, the names for the additional number of members allocated for the level of membership chosen.
The Contact Member is considered "member #1."

Add-on Member Information:
Please record ALL the names (up to the number you are alloted) of additional members in the Add-on Member area of this form.

Organizational Membership Categories *: (select one)

Supporter $200 - $499
2 individual memberships *
Benefactor $500 - $999
5 individual memberships *
Donor $1,000 - $1999
10 individual memberships *

          * includes contact person

Patron $2,000 - $4999
15 individual memberships *
Sustainer $5,000 +
up to 25 individual memberships *
Institutional $10,000 +
up to 50 individual memberships *

        * includes contact person

ORGANIZATION INFORMATION:

Organization Name:
Member 1: Contact Person Suffix:
Contact Person First Name:
Contact Person Middle Inital:
Contact Person Last Name:
Address (line 1):
Address (line 2):
City:
State / Province:
Zip Code:
Country:
Phone:
Email:
Web site:

Credit Card Information (VISA & MasterCard only)

Click here if billing information is same as above.
First Name:
Last Name:
Billing Address (line 1):
Address (line 2):
City:
State / Province:
Zip Code:
Country:
Card Type:
Credit Card Number:	3 digit code: (on reverse side of credit card)
Expiration:

Member Benefits | Membership Supported Activities | Member Organizations
Change of Address Form | Membership Form / Renewal main page | Membership Main Page

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United States Catholic Mission Association
Hecker Center
3025 4th Street, NE, Suite 100
Washington, DC 20017-1102
Tel: 202-832-3112
Fax: 202-832-3688
Email:
uscma@uscatholicmission.org