Name
Telephone Number
(Include your area code)
Address
City, State, and Zip Code
E-Mail Address
Fax Number
Employer
Address
City, State, and Zip Code
Birthdate
Month
/Date
/Year
Class of membership
Regular $20
Family $35
Youth $5
Affiliated $35
Guild $35
Young Professionals $50
Life $500
Champion of Equal Opportunity-CEO Society $1000
Method of payment
Check enclosed
VISA
Mastercard
Number
Expiration date
Signature (required for credit card transaction)
Print this page and fax to 502-585-2335 or mail to:
Louisville Urban League
Attn: Membership
1535 West Broadway
Louisville, KY 40203
Back to
Membership
page.
