Application For Membership

I hereby apply for the membership in the United Kirat Rai Organization of America (UKROA). I am at least 18 years of age and as applicable to the membership type below, I am a US Citizen or have a legal status in the US. I fully agree to abide by the bylaws, code of conduct, its mission, values, and objectives of the organization.

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Name *

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Last

Name Membership Type

Gender *

• Male
• Female
• Other

Address *

Phone

Email *

Chapter *--- Select One Chapter ---CaliforniaDMVPNew EnglandNew YorkTexas

Membership Type *--- Select Choice ---General Membership - $30.00Life Membership - $200.00Patron Membership - $1,001.00Associate Membership - $200.00Honorary Membership - $0.00Institutional / Corporate - $300.00

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• I hereby declare that I have filled in all the information correctly and completely. I am willingly applying to become a member of this organization.

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