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FREE ELECTRICITY FOR LIFE NUAF Membership Application

National Unions Of American Families
    22 S. 22nd Street, Philadelphia, PA  19103
NUAF Membership Application
All Information Is Strictly Confidential

         Yes, I believe in a strong coalition of American families that can build a better nation by strengthening one family at a time, and can be a collective bargaining power for The People. I would like to participate in the opportunity to impact my community and the country socially, economically and technologically through the NUAF Voice.

          I understand the cost to join NUAF is currently a special limited offer of $15, with no monthly dues until the Local Union structure is completed. NUAF anticipates that could be anywhere from 6 months to one year. I will be entitled to all benefits currently in place. Once the union structure is completed, continuing dues will be $8 per month. I can cancel at any time, simply by not paying the dues. If I discontinue membership, I will keep all benefits I purchased or was granted as a member, but I will not be able to renew yearly benefits. Free energy, if and when it happens, and the right to the phone service will continue.

Fill out the information shown below. Fields in bold are required.

HEAD OF HOUSEHOLD
First name:      Mid. Init.:    Last name: 
Date of Birth: (12/01/1960)    SS# (optional) (US 987-65-4321, Canada 987-654-321)
Registered voter: YesNo     Property Status: rentown     Number of members in family
Home Phone : (817-333-5555)   Work Phone: (817-333-5555)

Do you wish to participate in the Free Electricity Witness Program? (See Grassroots Support Program on www.nuaf.us website.): YesNo

MAILING ADDRESS
Street:
City:     State:   Zip: (US 12345 or 12345-1234, Canada A1B 2C3)    Country:

PHYSICAL ADDRESS (if different)
Street: (PO Box not permitted)
City:     State:   Zip: (US 12345 or 12345-1234, Canada A1B 2C3)   Country:

ADDITIONAL FAMILY MEMBERS

Name 		Date of Birth Registered
Voter? Y or N
  YesNo
  YesNo
  YesNo
  YesNo
  YesNo

Email address: (name@domainname.com)

Do you agree to the terms of this agreement? (yes)

Sponsoring Recruiter ID: 1417460.    Recruiter Name