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Institution Application

Before completing this application, please be sure your organization is not already a member. You can use your email address to check for an existing account/membership.

Required fields marked with an asterisk (*)

* Name of Institution:
Please verify your institution is not already a member; click here for a list.

Address1:
Address2:
City:

Country:	US Canada State: Zip: Province: Postal:
Type of Institution:	Public Private
Primay Phone:
Secondary Phone:
Fax:
Email:
Web Page:

Total Fall Housing:	Males: Females:
Total Occupancy Capacity:	Males: Females:

* First Name:	* Last Name:
Title:
Phone:
Fax:
* Email:

© 2006 UMR-ACUHO
The purpose of UMR-ACUHO shall be to promote and provide an environment of full opportunity and service for all persons regardless of ethnicity, creed/religion, age, gender, disability, sexual/affectional orientation, or any human circumstance. The Association will not arbitrarily discriminate in its programs, procedures, or activities.