New Member & Address Update Form

We're delighted you want to join ASIST. Please complete the following form and submit it. Current members may use this form to update their address.

Name:

UIAA Member:

Yes No

I am a new ASIST Volunteer

I am a current ASIST volunteer updating my information

Street Address:

City:

State:

Zip:

Home Telephone:

Work Telephone:

E-mail:

Fax#:

UI Degrees and years:

Optional: Racial/Ethnic/Tribal Affiliation Info

Alaskan Native or American Indian

African American/Black

Hispanic/Latino

Asian or Pacific Islander

White, not of HispanicLatino(a) origin

(Required)