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AWA MEMBERSHIP FORM New Member: Please complete this form to register as a member. Current Members: please use this form to renew your membership or update your contact details. Annual Membership Fee: 2,000 KSH. Please make checks payable to: American Womens Association (do not abbreviate) AMERICAN WOMEN'S ASSOCIATION PO Box 16517 Nairobi 00619 - KENYA Please provide the following contact information
Surname
First Name
Citizenship
Home Town & State
Profession
Employer
Is it an American Company ?	Yes No
E-mail
Business Phone
Home Phone
Mobile
Address: P O Box No.
City/Town
Postal Code/ZIP
Street Name
Residential Area
Husband's Surname
First Name
Employer
Business Phone
Is it an American Company?	Yes No
Citizenship

If you are willing to donate blood, please specify Blood Type
Self
Husband