Name:

Are you currently a college student? Yes No
If so, what college/university do you attend?
Does your college/university have a Ukrainian club? Yes No
Are you a member? Yes No
If so, what position(s) (if any) do you hold?
If you do not have a club, do you
socialize with other Ukrainians at school? Yes No
Where do you currently reside? City: State:

E-mail:
Phone: home cell dorm
Alternate Phone: home cell dorm

Mailing Address:
City: State:

Date of Birth (mm/dd/yyyy):

Favorite...
...city
...music artist
...ukrainian food
...ukrainian event
...summer vacation destination
...non-alcoholic beverage
...alcoholic beverage
...sport



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