Membership form


     MEMBERSHIP FORM   BOSTON Pan-African Forum       web-site: www.bpaf.org.

Name _______________________________________________________________

Street Address ________________________________________________________

City _____________________________   State_________       zip _____________

Home Tel (_____) ____________________   Work tel: (____)__________________

Email (we do not share this address) _______________________________________
Active Member dues (# at $25_____ Student/Youth member (# at $15_______
Other contribution ____________
Amount remitted _____________   Check No. ______________ Date ______________

 

Make check to: BPAF Send to Willard R. Johnson, MIT E53-367 Cambridge, MA 02139

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