Membership Form

First Name

Last Name

Email Address

Phone

Address

Apt #, Suite #, etc.

City

State

Zip Code

Organizational Membership – Billed Annually

$12 for each year

Your membership will begin upon completion of this form.

If you have a spouse, partner, or family members in the same household who would like to be a USP Member, you can use this form to begin and/or renew their membership as well!

**Membership dues will all be processed using the same payment method**

Is there a second person (over 18) in your household who would like to be an organizational member?

Yes

Second Member’s Info

2nd Member – Billed Annually

$12 for each year

Second Member’s First Name

Second Member’s Last Name

Second Member’s Email Address

Is there a third person (over 18) in your household who would like to be an organizational member?

Yes

Third Member’s Info

3rd Member – Billed Annually

$12 for each year

Third Member’s First Name

Third Member’s Last Name

Third Member’s Email Address

Is there a fourth person (over 18) in your household who would like to be an organizational member?

Yes

Fourth Member’s Info

4th Member – Billed Annually

$12 for each year

Fourth Member’s First Name

Fourth Member’s Last Name

Fourth Member’s Email Address

Is there a fifth person (over 18) in your household who would like to be an organizational member?

Yes

Fifth Member’s Info

5th Member – Billed Annually

$12 for each year

Fifth Member’s First Name

Fifth Member’s Last Name

Fifth Member’s Email Address

Is there a sixth person (over 18) in your household who would like to be an organizational member?

Yes

Sixth Member’s Info

6th Member – Billed Annually

$12 for each year

Sixth Member’s First Name

Sixth Member’s Last Name

Sixth Member’s Email Address

Is there a seventh person (over 18) in your household who would like to be an organizational member?

Yes

Seventh Member’s Info

7th Member – Billed Annually

$12 for each year

Seventh Member’s First Name

Seventh Member’s Last Name

Seventh Member’s Email Address

Is there an eighth person (over 18) in your household who would like to be an organizational member?

Yes

Eighth Member’s Info

8th Member – Billed Annually

$12 for each year

Eighth Member’s First Name

Eighth Member’s Last Name

Eighth Member’s Email Address

Is there a ninth person (over 18) in your household who would like to be an organizational member?

Yes

Ninth Member’s Info

9th Member – Billed Annually

$12 for each year

Ninth Member’s First Name

Ninth Member’s Last Name

Ninth Member’s Email Address

Is there a tenth person (over 18) in your household who would like to be an organizational member?

Yes

Tenth Member’s Info

10th Member – Billed Annually

$12 for each year

Tenth Member’s First Name

Tenth Member’s Last Name

Tenth Member’s Email Address

Almost there!

We want to remind you that your membership dues will be automatically withdrawn annually using the payment method you use today.

You will be reminded before funds are withdrawn, and you may update or cancel automatic payments at any time.

I agree to automatic payments

I DO NOT want automatic payments

No Problem!

While we recommend automatic payments so there is no lapse in your membership, we can process your payment and immediately cancel the automatic payments if that is what you prefer.

CANCEL automatic payments

ENABLE automatic payments

How can I pay by cash or check?

Payment by Cash or Check

We apologize, but this form cannot be used for cash or check payments.

To begin your membership, we will need the name and email address of each person that would like to be a USP Member sent, along with payment, to the address below:

Union Street Players
712 Union Street
Pella, IA 50219

Membership is $12 per person.
Make checks payable to: Union Street Players
Include on check: Membership

We do not accept cash through the mail. If you wish to make a cash payment for membership dues, please contact us at info@unionstreetplayers.org.

Please type your full legal name to act as a signature.

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union street players membership

A Lasting Impact on Your Community

Start or Renew Your Union Street Players Membership