This is the Member Agreement Form
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Why would you like to become a Member?
(Required)
What are your interests and values?
(Required)
What is/was your profession?
(Required)
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Member Level
Unified Member
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Date
MM slash DD slash YYYY
Name
(Required)
Please input your Full Name
Phone
(Required)
Please input a phone we can reach you at.
Email
(Required)
Enter Email
Confirm Email
Username
(Required)
This will be your username to login to Unified Fields and to any other websites in the network.
Password
(Required)
Enter Password
Confirm Password
This will be your password to login to Unified Fields and to any other websites in the network.
Electronic Assent
(Required)
I assent to use my electronic Autograph
Member Disclosure Regarding, entering this Covenant Electronically
Please read the information below carefully.
By checking the box above you are agreeing that you have reviewed this Member eFill Disclosure and assent and intend to use your electronic autograph instead of your wet ink autograph to indicate your intelligent acceptance of this Member Covenant. You also acknowledge that this is not your signature but your autograph, and that any occurrence of the word 'signature' that cannot be changed by us, as in the electronic signing apparatus, shall not mean signature but only and ever
autograph
.
You are not forced to sign this Member Covenant electronically.If you prefer not to sign this Covenant electronically, you may request paper copies from the Unified Fields by emailing our office - info@unifiedfields.io
Your Autograph
(Required)
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Autograph of Leader
(Required)
Waiting for another signer
Hidden
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
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