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Please select one:

Yes, I would like to become a member of The United States of Hope (USOH)!
No, Thanks. Instead, please send me more information about your organization.

If you would like to become a Member of USOH, please complete the application below and return to USOH, P.O. Box 8576,
Missoula, MT 59807 -or- scan and email to All donations are tax deductible to the fullest extent
of the law.

Name _________________________________________________ DOB: _______________ Age: ____

Address ________________________________________________________________________________
City/State/Zip __________________________________________________________________________
Country of Origin________________________________________
Email__________________________________________________ Phone _________________________

Marital Status: Single___ Married___ Divorced___ Widowed___

Are you a Veteran or active duty Soldier of the US Armed Forces? Yes__ No__
If so, what Branch? _____________________
Are you related to anyone who is a Veteran or active member of the US Armed Forces? Yes__ No__
Are you, or have you ever been, an Interpreter for US Armed Forces or NATO? Yes__ No___
Have you ever been a civilian member of an NGO in a war zone or natural disaster site? Yes__ No __
If so, where? __________________________
Would you like to receive our quarterly newsletter, USOH Hope Mail ? Yes __ No ___
How did you hear about USOH? ________________________________________

Annual Membership Type:

Individual or Family: $30.00 per year*

Business or Organization: $100.00 per year*
Lifetime Membership: $1,000 one-time*
*10% Discount on membership fees for Military personnel.

Total Dues: $____________

Type of Payment: Check Visa Master Card

Credit Card Number _____________________________ Exp. Date _________ Sec Code*______

Name on Credit Card ________________________________________________
*Sec Code is the last 3 digits of the numbers located in the signature box on the back of your credit card

I understand that by providing us your credit card information, you hereby agree that USOH may automatically renew your membership
each year by charging the applicable membership dues fee directly to your credit card. Please ensure we have updated credit card
information so the renewal may be processed. If you do not wish to have your dues automatically renewed each year, you may opt-out next
year by contacting USOH.

Signature ________________________________________________ Date ________________________

USOH P.O. Box 8576 Missoula, MT 59807 * 406.880.0696 * 406.370.5492 *