Application Form - NAMYAUSA

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  - Application Form
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- Naya Events
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CONTACT US

Home
About
- About Us
- MEMBERSHIP
  - Application Form
  - Bye-Law
ANNOUNCEMENT
HEALTH CLINIC
- Location
COMMITTEE
GALLERY
- Namyausa Events
- Naya Events
DONATION
- Events
- Membership Dues/Levies
SCHOLARSHIP
CONTACT US

MEMBERSHIP APPLICATION FORM

Contact Information

The cell phone listed will be used to call or text you individually or as a group

The email listed will be used to send you messages either individually or as a group

Name

Cell Phone

Home Phone

Street Address

City ST ZIP Code

References

List at least one NAMYAUSA member as your reference

List name(s) & phone Number(s) of current or past president/chairperson of other organizations you ever belong in & if none list none

Childrens’ Information

Names (Ages or DOB)

Corresponding Phone Number

Corresponding Emails

Committee Sign Up

Tell us in which committee(s) you are interested in serving: circle at least one

Youth leadership Event Planning Fundraising Tax/Audit By-law Sunshine

Please answer the following questions: MUST ANSWER ALL

I am a Nigerian-American mother by birth or marriage:

Yes No

If no explain

I have no criminal record or ever been convicted of felony:

Yes No

If no explain

I am a mother, my oldest child or step-child or custodial guardianship or god-child is at least 16 years old.

Yes No

If no explain

I commit to enroll my children into NAYA at age 18:

Yes No

If no explain

I have never been expelled or my membership terminated in any social organization:

Yes No

If no explain

Agreement and Signature

I agree that in the event of any dispute, I shall go through conflict resolution/arbitration process as stipulated in the by-law. Any legal actions resulting from matters of NAMYAUSA or her officers or members, the non-prevailing party shall be responsible for and will pay all attorneys’ fees, court costs and expenses incurred by the organization and/or her officers or members in defending any such action. By submitting this application, I affirm that the information provided herein are true and complete. I understand that any false information, statements, omissions, or other misrepresentations made by me on this application may result in my immediate termination as a member of NAMYAUSA and all monies paid and benefits owed will be forfeited. You have given your permission for your references to be checked.

Name

Signature

Date

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