Membership Type (Select One) Membership Type (Select One) Student $25 Non-Profit $50 Individual Professional $100 Small Business $150 Corporate Gold $2,500 (for those with 50+ employees) Corporate Jade $5,000 (for those with 100+ employees) Corporate Pearl $7,500 (for those with 500+ employees) Corporate Diamond $10,000 (for those with 1,000+ employees)

Full Name of Individual / Main Contact of Business

Title

Name of Business

Physical Address of Businesss or Organization

Email Address

Contact Phone

Social Media or LinkedIn

Industry (e.g. Food, Banking, Government, Health)

Are you interested in supporting a particular UACC event? Access Asia, Business Summit, Golf Tournament, Gala, Membership, etc. Please specify.

If there is information you would like for us to omit from our website directory, please check the boxes for those fields (Optional) If there is information you would like for us to omit from our website directory, please check the boxes for those fields (Optional) Full Name of Individual / Main Contact of Business Title Name of Business Physical Address of Businesss or Organization Email Address Contact Phone Social Media or LinkedIn Industry (e.g. Food, Banking, Government, Health)

Message (Optional)

If you have already paid for the membership, please check the following box If you have already paid for the membership, please check the following box I have paid via Venmo for the membership