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Connect Unity Fellowship Membership

Complete this form to become a member of Connect Unity Fellowship.

Name*

DOB*

Date of Membership

Spouses Name

Sprouses DOB

Spouses Date of Membership

Street Address*

City*

State*

Zip Code*

Home Phone *

Mobile Phone

Date of Wedding Anniversary

Email Address*

Dependent 1

Male or Female

Dependent 1 DOB

Dependent 2

Male or Female

Dependent 2 DOB

Dependent 3

Male or Female

Dependent 3 DOB

Dependent 4

Male or Female

Dependent 4 DOB

Emergency Contact*

Emergency Contact Phone Number*

Connect Unity Fellowship Membership

Alternatively, download the CUF membership data form and email it to  connectunityfellowship@gmail.com

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