Foundation
for Democracy In Africa
Membership
OR
Print this form in your browser and send form with payment to:
The Foundation for Democracy in Africa
1319 F Street, NW, Suite 305
Washington DC 20004
Tel: 202-331-1333 · Fax: 202-331-8547
E-mail: info@democracy-africa.org
| Name : | ________________________________ |
| Address: | ________________________________ |
| City: | ________________________________ |
| State/Province/Zip Code: | ________________________________ |
| Country: | ________________________________ |
| Tel. Business: | ________________________________ |
| Tel. Residence: | ________________________________ |
| Fax: | ________________________________ |
| Employer: | ________________________________ |
| Birth date: | ________________________________ |
Please Circle the Level of Membership:
Student USD $10
Grassroot USD $25
Advisory USD $500
Corporate USD $1,000
Trustee USD $2,000
©2004 The Foundation for Democracy in Africa.
All Rights Reserved.
