Join On-line:

I oppose UCITA.

Please select: Mr. Ms. Dr.

Full Name (First - Middle Initial - Last):

Mailing Address:
Street:
City:
State: Zip:

Phone:
Fax:
E-Mail:

If you would like to join and be listed as a company or organization, please complete the following:

Company or Organization Name:

Person authorizing membership for your company or organization:

Title:

I can help defeat UCITA by:
granting permission to list my company or organization as a member of AFFECT
distributing information
speaking at public events
writing legislators
authoring letters to the editor
sending information to employees, colleagues and/or members
placing an article in your employee/member newsletter
contributing financially (Click here for more information)

IMPORTANT: Current or former titles and company or organization affiliation are for identification purposes and will be designated as such. We may call to verify the information submitted on this form.