MEMBERSHIP

Membership of ACHA is open to adults of any nationality, religion, or ethnic background, who

  1. Dedicate themselves to its objectives, and its mission;
  2. Agree to follow the ACHA Declaration of Commitment in their day to day conduct;
  3. Complete ACHA Membership Application; and
  4. Pay annual dues.
MEMBERSHIP APPLICATION

Please write legibly, preferably in capital letters, and with a check made out to ACHA, mail it, to Association for Communal Harmony, 4410 Verda Lane NE, Keizer, OR, USA. Membership is renewable each year on January 1.
 
NAME: ______________________ ______________________ ______________________
Mr/Miss/Mrs/Dr
First
Middle
Last
ADDRESS: _________________________________________________ _______________________________
P.O Box or Street Address
Apt. #
______________________ ______________________ ______________________ ______________________
City or Province
State
Zip Code/PIN
Country
PHONE: (_____)_____________________ (_____)_______________________ (____)______________________
Day 
Evening
Fax
_____________________________________________ _____________________________________________
Email address
Website URL

*Annual dues are payable in the currency of the country the applicant’s current residence (e.g., In U.K. dues are 10 Pounds/Euros for individuals, and 25 Pounds/Euros for couples or families), except that in South Asian countries the amount is multiplied by 10 (e.g., in India dues are Rs.100 for individuals, and Rs. 250 for couples or families, and in Bangladesh dues are100 Taka for individuals, and 250 Taka for couples or families)

CHECK ENCLOSED: DUES (Check one)
Individual $10 _____ Couple $20/200  ______ Family $25______ Life $200/ _____

 TAX DEDUCTIBLE DONATION $ __________ TOTAL AMOUNT ENCLOSED $ _______

Any information about yourself that you would like to share with us:

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