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 BPAF c/o Dr. Joyce Hope-Scott 683 R. Boylston St. Newton MA 02461
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