Step 2: Membership Form

First Name:
Last Name:
Middle Intial:
Email Address:
Retype Address:
Job Title:
Street Address:
City:
State:
Zip Code:
Telephone:
Date of Birth:
Social Security Number:
Photo ID (optional):



Monthly membership dues shall be $40.00 per month and shall be due and payable on the first day of every month.

Any member in arrears for three months in regard to dues, will be designated as delinquent and not in good standing, unless officially exonerated from payment of same, and shall be required to pay a reinstatement fee of $100.00 in addition to all back dues before good standing can be restored.

I certify by my typed signature below that I agree with the information stated in the Obligation of the NPUA. The typed version of my name is being accepted as my original signature pursuant to the Federal Electronic Signature Act, effective October 1, 2000.
Please type your signature in this field, using a space between your First name and Last name.
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