Membership Application

Thu, 10/02/2008 - 18:08 — webmaster

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Name and Contact Information

First Name: *

Last Name: *

Country of Residence: *

Phone: *

Email Address:

Areas of Interest

I would like to volunteer by:

Fund Raising

Committee Member

Feasibility study on programs and project priorities

Oversight and coordination of projects on a local level

Other (please specify in the comment area below)

Membership fees

I would like to contribute:

20/per 1 month

60/per 3 months

240/per year

contributions are done in the currency of your place of residence.

One time annual contribution of:

Can we display you on our Members List?: *

Yes

We will only display your name and country our Members List.

Comment:

Enter any additional information that you would like included with your application here.

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Math Question: * 4 + 12 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Korem & Surrounding Communities Development Organization