Membership Application & Dues Payment

New members may copy and paste the information below into your favorite text editing program, or simply print this page and mail it to us!

NEW MEMBERSHIP APPLICATION

FOR

UNION CAMPGROUND

CEMETERY ASSOCIATION, INC.

Name ___________________________________________

Address _________________________________________

              __________________________________________

Phone number(s) ___________________________________

Email Address _____________________________________

Individual ($15) membership ___    Family ($25) membership ____

Do you have any family members buried at the cemetery (and who)? ___________________________________________

___________________________________________________________________________________________________________________

How did you hear about our organization? _______________________________________________________________________

 ___________________________________________________________________________________________________________________

Current members can mail their dues to the below address, no form is necessary.

Please copy this form and mail it and your check to:

Doug Rayl, Treasurer
Union Campground Cemetery Association
252 Hightower St.
Nixa, MO  65714