UNITED FEDERATED PLANETS

MEMBERSHIP APPLICATION FORM

A different kind of Star Trek fan club dedicated to the vision and memory of Gene Roddenberry Where your imagination is your only limit!!

mikeferg1@yahoo.com         http:www.ufphq.com 

TO JOIN: SIMPLY FILL OUT THIS APPLICATION AND RETURN IT WITH THE APPROPRIATE FEE TO: UNITED FEDERATED PLANETS; 300 OAK STREET; MIDWEST CITY, OK 73110. PLEASE MAKE CHECKS AND MONEY ORDERS PAYABLE TO: UNITED FEDERATED PLANETS.

For those who wish to use the free membership or just want to obtain a membership number quicker, you can transmit your application in today and send the fees in separately by following the transmission instructions below.

TRANSMISSION INSTRUCTIONS:

Please select edit and select all, then edit and copy, then click on mikeferg1@yahoo.com , then paste on your E-Mail screen, fill out the form with your new information and then send it as an e-mail.

CHECK YOUR UFP LIFE-TIME MEMBERSHIP CHOICE HERE PLEASE:

(  )INDIVIDUAL U.S., A.P.O. AND CANADIAN FEE OF $5.00 PLUS 42 CENTS PER ADDITIONAL FAMILY MEMBER

(  )INDIVIDUAL OVERSEAS FOREIGN FEE OF $10.00 PLUS 42 CENTS PER ADDITIONAL FAMILY MEMBER

(  )INDIVIDUAL ON-LINE U.S., A.P.O. AND CANADIAN FEE OF $3.00 PLUS 42 CENTS PER ADDITIONAL FAMILY MEMBER

(  )INDIVIDUAL ON-LINE OVERSEAS FOREIGN FEE OF $5.00 PLUS 42 CENTS PER ADDITIONAL FAMILY MEMBER 

(  )NO MEMBERSHIP FEES INCLUDED, REQUEST ONLY A MEMBERSHIP NUMBER.  ALL FEES PAID IN U.S. CURRENCY, CHECK OR MONEY ORDER.

*****PLEASE PRINT NEATLY*****PLEASE PRINT NEATLY*****

FULL NAME:

COMPLETE MAILING ADDRESS:

HOME TELEPHONE NUMBER: (         )

FAX NUMBER: (      )

E-MAIL ADDRESS:

WEB PAGE ADDRESS: http://

DATE OF BIRTH:

SEX:

REAL LIFE OCCUPATION:

SELECT YOUR UFP FAN SECTOR (ONLY ONE) AND ENTER YOUR CAREER INTEREST FOUND BELOW:

FAN SECTOR:

CAREER INTEREST:

FAN SECTORS AND CAREER INTERESTS

STARFLEET COMMAND * Starfleet Operations * Starbase Operations * Medical, Science * S.E.A.L.S., * Bridge Command * Starfleet Intelligence * Fighter Operations * Chaplain Corps * Counselor Corps * Engineering * Security * Alien Contact * Or whatever you want to be

CIVILIAN * Department of Civilian Military Alliance * Department of Interstellar Relations * Department of Interstellar Trade and Commerce * Department of Colonization * Department of Planetary Development * Department of Scientific Research and Development * Department of Justice 207 Department of The Interior * Department of Education * Department of Finance * Free Trader * Merchant * Terra-Forming * Club Owner * X-Files Special Agent *Judge * UFP-FBI Marshal * Accountant * Medical * Colonial Services * Or whatever you want to be

ALIEN FLEET * Romulan * Klingon * Borg * Ferengi * Orion * Q * Gorn * Benzite * Jem’hadar * Cardassian * Vulcan * Bajoran * Vorgon * Terran Empire * Or whatever you want to be

MARINE CORPS * Operations * Medical * Security * Bridge Command * Intelligence * Infantry * Strike Force * Or whatever you want to be

BATTLESTAR GALACTICA * Bridge Command * Pilot * Diplomatic Corps * Flight Operations * Sciences * Support Operations * Security * Engineering * Medical * Civilian * Cylon Fleet * Or whatever you want to be

BABYLON 5 First Select Earth Forces OR Alliance Forces THEN * Starfury Pilot * Psi Corps * Med-Lab * Security * Ambassador * Intelligence * Communications * Engineering * Legal * Tactical * Science * Navigator * Marines * Army * Archaeologist * Xeno-Biologist * Zocolo Merchant * League of Non-aligned Worlds * Shadows Fleet * Or whatever you want to be

FEDERATED INTELLIGENCE AGENCY * Operative * Information Analyst

DELTA QUADRANT MILITARY ALLIANCE * Whatever you want to be

STAR WARS * Jedi Knight * Imperial Storm Trooper * Alliance Rebel * Deathstar Technician * Or whatever you want to be

HIGHLANDER * Immortal * Watcher * Or whatever you want to be

THE UFP CHAPTER YOU WANT TO JOIN:

YOUR UFP RACE YOU WANT TO BE:

KNOWN UFP RACES

* Klingon * Romulan * Bajoran * Vulcan * Betazoid * Changling * Cardassian * Android * Timelord * Highlander * Jem’hadar * Chamiloid * Minbari * Human * Vampire * Cylon * Vorgon * Centauri * Drazi * Shadow * Vorlon * Abbai * Brakiri * Gaim * Ipsha * Llort * Markab * pak'ma'ra * Vree * Bajoran * Or whatever you want to be

( ) PLEASE SEND ME INFORMATION ON STARTING A UFP CHAPTER IN MY COMMUNITY

( ) I WOULD LIKE TO SUBSCRIBE TO THE UFP NEWSLETTER "SUBSPACE" AT THIS TIME AND ENCLOSE THE ANNUAL FEE OF $10.00 FOR U.S., CANADIAN AND APO MEMBERS OR $15.00 FOR OVERSEAS FOREIGN MEMBERS.

( ) I WANT TO APPLY FOR A POSITION ON THE UFP ASSEMBLY TO REPRESENT MY RACE. ( ) I WANT TO APPLY FOR A POSITION ON THE UFP SECURITY COUNCIL ( ) I WANT TO APPLY FOR A POSITION ON THE UFP SOCIAL AND ECONOMIC COUNCIL ( ) I WOULD LIKE TO JOIN THE UFP TITANIC APPRECIATION SOCIETY

YOU MAY PURCHASE THE FOLLOWING UFP MERCHANDISE ITEMS AT THE TIME YOU JOIN:

(  ) OFFICIAL UFP PATCHES at $3.00 each = $

(  ) OFFICIAL UFP BUTTONS at $1.00 each = $

(  ) OFFICIAL UFP MAGNETS at $1.00 each = $

TOTAL AMOUNT ENCLOSED FOR MERCHANDISE PURCHASES = $