Last Name: First Name: MI:
Gender: Spouse Name:
Address:
City: State: Zip:
E-mail:
Home Phone: Work Phone:
Occupation:
Village:
Or Town (non Agulu members only):
· Registration fee is $50.00 ($75.00 couple). · Annual donation is $30.00 ($45.00 couple). · One time development donation $500.00 (payment could be arranged in not more than three installments). · NB: Initial Registration fee and annual donation (in full) are non-negotiable and should accompany all completed applications. · All married men must register as couples. · All payments in checks or money order to IAD (no cash by mail please). · IAD Bylaw would be sent to applicant on admission to membership. · By appending your signature, you agree to abide with the terms stipulated in this application, and understand that all monies paid to IAD are non-refundable. ******************************************************************************************** Direct all inquiries to: Dr. Emmanuel Onyeozili P.O. Box 3938, Salisbury, MD. 21802 e-mail: ozili@yahoo.com Phone: 410-677-6760