credit union/organization

address (supervisory committee's, if different from main address)

city/state/zip

cu telephone

cu fax

cu web address

sponsor credit union (required for associate members)


Check the appropriate membership category:

Regular - $400 (credit union supervisory or auditing committee)

Associate - $500 (organizations working with credit unions)
contact name

contact title

contact e-mail


List all committee members and their e-mail addresses:

chairman's name

e-mail


name

e-mail


name

e-mail


name

e-mail


name

e-mail


name

e-mail

Internal Auditor:
name

title

e-mail


Please note: Your application will not be processed until we
receive dues payment in full (see amounts above).

Remit checks to:
NACUSAC
PO Box 160
Del Mar, CA 92014-0160

Thank you!