MEMBERSHIP APPLICATION

Urban League of Union County, Inc.

288 N. Broad Street, P.O. Box 730
Elizabeth, NJ 07208

(908) 351-7200

 

Home Address

Name _____________________________________________________

Address _________________________________ Apartment No. _____

City __________________________________ State _____ Zip _______

Phone ______________________ Email__________________________

Business Address

Name _____________________________________________________

Title ______________________________________________________

Company __________________________________________________

Address Line 1 _______________________________ Suite __________

Address Line 2 ______________________________________________

City _________________________________ State ____ Zip _________

Phone ______________________ Email_________________________

Check one:

          Senior / Student ($5.00)_______

Regular ($10.00)__________

 
Family ($25.00)_____________
Professional ($35.00)_____


Club ($50.00) _____________

Patron ($75.00 )__________

Institutions, Churches ($150.00) ________________

Sign____________________________Date____________________________________
 

CONTRIBUTIONS TAX DEDUCTIBLE FOR INCOME TAX PURPOSES

 
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