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Membership Application Form

First Name:	(required)
Last Name:	(required)
Email:	(required)
Address:	(required)
City:	(required)
State:	(required)
Zip:	(required)
Country:	(required)
Telephone:	(required)

Method of payment for annual membership fee:

General ($30.00) and Students ($10):

Check*:

Paypal**:

I hereby affirm that my work for the Asian-American Network Against the Abuse of Human Rights (ANAA) will be in accordance with the vision and mission statement of ANAA. In addition, my work for ANAA will be in accordance with the ANAA by-laws ***.

Completion of the form in its entirety is requested. It will help us develop a data base and ease communication among ourselves. Submission of the form and payment of the fee by Nov 30/06 will ensure that a member will be eligible to vote in ANAA elections.

* Check should be made payable to ANAA (write in memo ANAA Membership) and send to 3065 Southern Loop, Kingman, AZ 86401

**To Pay via Pay Pal

General Maembership

Student Membership

Download Application Form in WORD or PDF format

*** ANAA By-laws ***

For any Questions Contact: 3065 Southern Loop, Kingman, AZ 86401: Phone: 928-550-0062, email: 4anaapk@gmail.com, website: www.4anaa.org