Membership Application

Use the form below to become a member of UULLA and start taking advantage of our benefits and support system within our industry!

To submit an application, fill out this form completely on-screen ; then print this form by clicking on the Printer icon on your web browser or using the File/Print menu function; then Fax this form to 925.969.9184. You should then send a check to UULLA for the appropriate amount ($500 for Vendor; $325 for General) and mail to the address below. You may alternately choose to print this form and mail it along with your check. (Note: Our on-line application process will be avaiable soon!)

Bob Baamonde - Treasurer
c/o C & C Leak Detection
69401 16th Section Road
Pearl River, LA 70452

Indicate the type of Membership you are applying for:

General Membership  ($325)
Vendor/Manufacturer Membership ($500)

Please provide the following information:

Company Name
Contact Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Main Office Phone
Contact Phone
FAX
E-mail
Website Address
Geographic Service
Coverage Area
Description of Services
Your Company Provides:

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Revised: 09/19/05