debes membership

—MEMBERSHIP FORM

APPLY TO BECOME A MEMBER

ኣባል ንምዃን መመልከቲ ቅጥዒ

Complete the membership application form to join the Eritrean-American Debes Association of Georgia. Please provide your personal information and beneficiary details carefully so your membership record can be processed correctly.

Applicant Information

Full Name *

Phone Number *

Email Address *

Date of birth *

Driver License / ID Number *

Street Address

City

State

Country

Postal Code

Payment Information *

$ 150

Other amount

Billing Frequency

Primary Beneficiary Information

Primary Beneficiary Name *

Primary Beneficiary Phone Number *

Primary Beneficiary Address *

Relationship to Applicant *

Secondary Beneficiary Information

Small note: Only complete this section if the primary beneficiary is not available.

Secondary Beneficiary Name

Secondary Beneficiary Phone Number

Secondary Beneficiary Address

Your Relationship to Applicant

Applicant Confirmation

Applicant Name *

A member-supported mutual-aid association serving Eritrean-American families across Georgia.

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ማሕበር ደበስ ኤርትራውያን-ኣመሪካውያን ኣብ ጆርጅያ