Application for Fraternal Membership Step 1 of 2 50% Proposed Member Information * Indicates a Required FieldAre you applying for membership as an insurance agent?*- Please SelectYesNoName:* First Name Middle Initial Last Name Email:* Telephone:*Date of Birth:* MM slash DD slash YYYY Street Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CanadaUnited States Country Sponsor Member Number: If you know the council you wish to join, enter the council number: Please read the TERMS AND CONDITIONS: Please enroll me for membership in The Order of United Commercial Travelers of America (UCT). I understand UCT is a fraternal benefit society, and I agree to abide by the Society's Constitution and Bylaws (PDF).* I have read and agree to the TERMS AND CONDITIONS Review members information for Fraternal Application: Please verify that your information is correctUnique ID{all_fields}Your total due: $30.00PhoneThis field is for validation purposes and should be left unchanged. Δ