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UIA Gift of Membership Application
Membership applications require UIA Board approval and are reviewed monthly.
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Your Information
First Name:
*
Your answer
Last Name:
*
Your answer
Phone:
*
Your answer
Email:
Your answer
Are you a member of the Ukrainian Institute of America?
*
Yes
No
I don't know
Please choose your payment plan for the gift
*
Membership - Initiation Fee is tax deductible. Tax Identification number: 13-1832391
PLAN A: $2,500.00 Full Member (should be paid in full)
PLAN B: $625.00 Partial Member (balance for becoming a Full Member should be paid within one year)
Gift Recipient Information
First Name:
*
Your answer
Middle Name:
Your answer
Last Name:
*
Your answer
Date of Birth:
*
MM
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DD
/
YYYY
Place of Birth:
Your answer
Citizenship:
Your answer
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