Certified Credit Union Supervisory Committee Member Enrollment

Complete and submit the enrollment form online by filling in the fields below. If you have questions, please email us or call 800-356-9655, ext. 4249.

If you would like to enroll via fax, fax a completed printed form to 608-231-4333. If you would like to enroll via mail, mail a completed printed form to:

CUNA Supervisory Committee Designation
PO Box 431
Madison, WI 53701-0431 

YOUR CONTACT INFORMATION

Full Name:
Street Address:
City:
State:
Zip:
Phone Number:
Email Address:

CREDIT UNION INFORMATION

Credit Union:
CUID:
CU Street Address:
CU PO Box:
CU City:
CU State:
CU Zip:
CU Phone Number:
CU Email Address:
Present Position:

ADDITIONAL INFORMATION

How would you prefer to be contacted? (choose one)

       

How did you hear about the CCUSC designation?