Ethiopian Community Membership Form

Name *

First

Last

Layout

Email *

Date of Birth//

Layout

Phone

Cell Phone *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Profession/Employment

Job Title / Profession

Spouse

Name

First

Last

Layout

Cell Phone *

Birth Date *

Children under 23

Layout

Child 1 Name

Child 2 Name

Child 3 Name

Child 4 Name

Date of Birth 1

Date of Birth 2

Date of Birth 3

Date of Birth 4

እኔ የኢትዮጵያ ኮሙኒቲ መረዳጃ ማህበር አባል ለመሆን ይህንን ቅጽ ስፈርም የመተዳደሪያ ደንቡን በማንበብና በመረዳት መብትና ግዴታየን በሚገባ አውቄ ነው። I agree to be bound by the Bylaws of the Ethiopian Community, Inc, having read and understood all the stated terms and conditions thereof.

Signature

Checkbox Items

Full Membership Registration - Community($60/year) & Meredaja ($100 Registration one time fee)
Only Community Membership ($60 /Year)
Only ECNOVA Meredaja - $140 one time registration and 60.00 annual mgmt. Fee

Pay your Membership & Registration Fee *

PayPal Commerce payments are disabled because your connection is not set up correctly. Please ask your site administrator to check the connection settings.