First Name:*  
Middle Name:
Last Name:*  
Address 1:*  
Address 2:  
City:*  
State:*       Zip Code:*   -
Telephone:*  
(xxx-xxx-xxxx)		 Telephone 2:  
(xxx-xxx-xxxx)
Email:*  
Please Check:*
Combined Annual Dues:  $80.00 ($50.00 National, $30.00 Local)
Local Dues Only:  $30.00
Lifetime Memberships -
Silver:  $300.00
Gold:  $500.00
Platinum:  $750.00
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Membership/Donations may be made via

Use the email uapbkc@gmail.com

Or

Please make checks payable to:

Greater Kansas City Chapter UAPB/AM&N Alumni Association

Mail Check to:

Mailing Address:
UAPB/ Arkansas AM&N Alumni Association – Greater Kansas City Chapter
P.O. Box 300382
Kansas City, Mo 64130

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