Date of Birth*:

Mailing Address*:

Unit/Apt#::

City*: State*: Zip*:

Telephone Number*:

Email Address*:

Ethnicity*:
Membership is only open to SGL women of African Heritage.
African
African American/Black
Belizean
Caribbean
Dominican Republican
Hispanic/Latina
West Indian
Mix/Biracial Specify:
Other Specify:

Image URL
(e.g. http://www.uloah.com/sample.jpg)


All memberships require a current headshot. This picture will be used solely for your membership card and will not be sold, shared or distributed to any outside entity. Additionally, membership photos will never be used for promotional materials of any medium (e.g. flyers, brochure, website, etc...) without explicit prior consent.

Photos should already be stored within a weblog, profile, personal/business website or photo album (e.g. Yahoo! Photos, Flickr, Blogger, etc...) Please type in the URL of the picture in the space provided above.

If you would rather email your picture directly to us, please send it as an attachment to memberships@uloah.com with ULOAH MEMBERSHIP PHOTO within the subject line.

Committee Participation
I would like to work on the following committees:

Sistahfest Committee
Fundraising Committee
Strategic Planning Committee
Nominating Committee
Volunteer Committee