National Unions Of American Families

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.

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

When completed, Print the form and mail to:

NUAF Administrative Services

P. O. Box 1570

Mechanicsville, VA 23116

HEAD OF HOUSEHOLD
First name: Last name:
Date of Birth: (Mo/Date/Year) SS# (optional) (US 987-65-4321, Canada 987-654-321)
Registered voter: Yes No Property Status: rent own 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? YesNo

MAILING ADDRESS
Street: Apt./Suite/Bldg/Lot/Site number:
City: State: AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NU NV NW NY OH OK ON OR PA PEI QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT Zip: (US 12345 or 12345-1234, Canada A1B 2C3) [1] [1] Country: USA Canada

PHYSICAL ADDRESS (if different)
Street: (PO Box not permitted) Apt./Suite/Bldg/Lot/Site number:
City: State: AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NU NV NW NY OH OK ON OR PA PEI QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT Zip: (US 12345 or 12345-1234, Canada A1B 2C3)

Country: USA Canada

ADDITIONAL FAMILY MEMBERS (living with you)
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: 2418640: Recruiter Name: Edward J. Leary

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