Membership Form

Sudanese American Development Organization (SACDO)

Membership Form

5622 Columbia Pike. Suite #305 Falls Church, VA 22041
Phone : (703) 575-4473
Fax: (703) 575-4473

P.O. Box 151 201 W. Broad Street Falls Church , VA 22046 http://www.sacdo.com

I, undersigned, hereby certify that I approve and adhere to the Declarations of principles and ask that my name be inscribed in the Sudanese American Community Development Organization (SACDO) Membership Book

Signature:

Do you want your name & address to be included and published in the SACDO Directory?

Date:

Last: Last:

First Name: Middle: Spouse First Name: Middle:

Home Address:

Address1: :

City: State: Phone-1: Mobile:

Email:

Dependent Information (18 years or less):

First Name Last Name

Zip Code:

Sex

Date of Birth

Payment Enclosed:

Amount ($): Cash or Check?

If Check, Check #?

Fees : payable to SACDO's Treasurer by cash receipt, Check, Money Order or Cashier's check mailed to the above address. Registration fees $10. Dues $5 (Individual) or $10 (family) per month, payable annually, biannually, quarterly or monthly. If annually, dues are only $50