Congolese Community of Washington Metropolitan (CCWM)
Electronic Membership Form
$5 Membership Fee + $10 Application Fee
Today's Date *
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Select one from drop down *
Name *
Your answer
Street Name + No. , Apt. No., Suite *
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City *
Your answer
State *
Zip Code *
Your answer
Gender *
Age Range *
Required
Civil Status *
Which contribution are you making? *
Required
For all contributions we will email a payment request via PayPal or other billing methodology *
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What is your phone number? *
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