1. Which UNIA-ACL Division are you interested in Joining?
2. Name:
Last
 Male
 Female
Nickname
First
3. Mailing Address:
street
street number
 Apt #
state or region
city
 country
 Zip Code
4.  Phone Number
Cell
 Home
Business
5. Email Address:
 6. Website Address:
8. I am African Descent:
Place of Birth:
7. Birthday:
City/State/Country
Month/Date/Year
10.  Weight
12.  Eye Color
9.  Height
 11.  Hair Color
13.  Spiritual Affiliation:
 14.  Occupation:
15.  In Case of emergency, please contact:
 Relationship:
Mailing Address:
street
street number
 Apt #
 Phone Number
state or region
city
 country
 Zip Code
16.  Why do you want to join the UNIA-ACL?
17.  Skills I have that will benefit the African Race?
18. Membership was Referred by:
19. Today's Date:
Month/Date/Year
20. Comments and Questions:
Instructions:
1. You have to be an African Black Person to Join the UNIA-ACL.
2. There is a one time $10 Joining Fee to join the UNIA-ACL.
2. Complete the UNIA-ACL Division Membership Application Below.
3. The dues for the UNIA-ACL is $3 each month and a $10 Assessment Fee each year.
4. After you complete the UNIA-ACL online membership application,  your application will be sent to the
nearest UNIA-ACL Division to where you live. You will be contacted to pay your joining fee and dues.
5.  Send a copy of your picture ID to unia-acl@cbpm.org .
UNIA-ACL Division's Online Membership Application
Thank you in advance for becoming a member of the UNIA-ACL
Verify Membership, All new members:
1. Call 678-827-2276 to verify your application has been received.
2. Send a picture of yourself with your name and phone number to unia-acl@cbpm.org
3. NOTE: If you are using a cell phone to complete your application, sometimes the application may not be
submitted. To solve this problem, complete your UNIA-ACL Membership Application on a Desk Top or a Lap
Top and you won't have any problems joining. You may also save your application as a PDF and send to
unia-acl@cbpm.org