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African American Network Community Association

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AANCA MEMBERSHIP APPLICATION

*PLEASE SELECT ONE:

INDIVIDUAL ($39)

FAMILY I (limit 6) ($50)

FAMILY II (limit 10) ($100)

BUSINESS ($100)

LIFETIME ($1200)

All Prices are per year, with the exception of Lifetime. You may upgrade your membership at any time.

*FULL NAME

*EMAIL ADDRESS

COMPANY NAME (if applicable)

TYPE OF BUSINESS (if applicable)

*MAILING ADDRESS

Please Enter Full Address, City, State, Zip

*CELL/HOME PHONE

OFFICE PHONE

REFERRAL NAME

*Signature

By signing/typing your signature, you attest that all information entered above is true and accurate.

*Date

After submitting your application, you will automatically be taken to a new tab to submit your payment.

Call us:

(227)204-6942

Find us:

1775 I Street, NW, SUITE 1150,

Washington, DC 20006

Email us:

africanamericanetwork@gmail.com

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