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RETIRED UNITED PILOTS' ASSOCIATION MEMBERSHIP APPLICATION

NAME:____________________________

ADDRESS:_________________________

___________________________________

Enclose a check, made out to “RUPA” in the amount of $25.00 to cover the annual cost of publishing and mailing the RUPANEWS.

The minimum $25 fee for publishing and mailing is due each year on your birthday.

BIRTH DATE _________________ DATE EMPLOYED BY UAL____________________

LAST DOMICILE ______________ RETIREMENT DATE _________________________

MAILING ADDRESS______________________________________ (If other than above)

______________________________________

______________________________________

E-Mail Address:_________________________

TELEPHONE #________________________ WIFE'S NAME ________________________

PLEASE INDICATE YOUR INTERESTS AS A RUPA MEMBER:

1 ( ) Candidate for officer position or committee member.

2 ( ) Writing for NEWSLETTER or assisting in its production.

3 ( ) Attending "Folding & Stuffing' sessions.

4 ( ) Representative for your geographic area.

5 ( ) I would help in planning convention and convention activities.

6 ( ) I would help in planning local activities, i.e. telephone committee, etc.

7 ( ) None of the above.

8 ( ) I don't wish to participate in RUPA activities.

9 ( ) Other interests (please explain).

COMMENTS:

W E L C O M E!

PLEASE RETURN TO:

RUPA
PO BOX 275
HALF MOON BAY, CA 94019-0275