ACFUSA Membership Database Survey
Thank you for being a valuable member of ACF. Please complete this survey to update our records. Everyone over 18 should complete this form. Only one form should be completed for married couples.
Email address *
ACF Chapter *
First Name *
Your answer
Last Name *
Your answer
Current ACF Leadership Position (if any) - Example: President, Secretary, etc.
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
African Nationality/Heritage *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Marital Status
Spouse's First Name
Your answer
Spouse's Email
Your answer
Spouse's Phone Number
Your answer
Please list the names and ages of your children
Please list names of all of your children.
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Child Name
Your answer
Child Birthday
MM
/
DD
/
YYYY
Tell us about your business
If you (or your spouse) do not own your own business, please skip this section. If you do, please share information about the business so we can help you advertise and network through ACF.
Profession
Your answer
Business Name
Your answer
Job Title
Your answer
Business Description
Your answer
Website URL
Your answer
Instagram URL
Your answer
Facebook URL
Your answer
Twitter URL
Your answer
Thank You
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