New Membership Application
Membership Type *
Required
If you have selected family membership please mention the number of the child/ren included in the family
Your answer
First Name *
Your answer
Last Name *
Your answer
Spouse’s First Name
Your answer
Spouse’s Last Name
Your answer
Address (Street) *
Please make sure you use the same address when paying the membership in Paypal
Your answer
Address (City) *
Your answer
Address (State) *
Your answer
Address (ZIP Code) *
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email *
To receive email from AMDA email system you need to subscribe to the system separately by visiting www.amda.us. Please make sure you use the same address when paying the membership in Paypal
Your answer
Heritage/Country of Origin(s)
To support AMDA’s objective of representative governance
Your answer
Volunteer Preference: (AMDA encourages its membership to volunteer in any of its many activities. Please indicate which of the following activities you are interested for volunteering:)
Check-o-matic Information (Minimum $25 per month): Are you interested in a monthly Check-o-matic deduction for membership renewal fee or donation? *
Member’s Rights and Responsibilities:
Member’s rights, privileges, and responsibilities are described in detail in the constitution and in the by-laws of AMDA. Every applicant is encouraged to read the constitution before signing the application for membership. The constitution is available at AMDA website (www.amda.us).
Declaration:
I/We the undersigned hereby agree to abide by the constitution and by-laws of AMDA:
Applicant Signature *
Please put your email address as signature confirmation
Your answer
Applicant Signature (Spouse)
Please put your spouse's email address as signature confirmation
Your answer
Membership Fees Payment
After submitting the membership form you will be directed to a confirmation page with link to Paypal to submit the membership fees. Please use that link to submit your membership fees. Once we receive the membership fees and the membership is approved, InshaAllah we will send you an email notifying you of the application status.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms