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Become a Member

Fill out the registration form below to apply for CCUSA membership.

Member Registration Form

Cabinda Community in the United States of America

All fields are required (*). The form cannot be submitted until every field is completed.

Personal Information

Full Name *

Date of Birth *

Place of Birth *

Gender *

Marital Status *

Contact Information

Current Address *

City *

State *

Zip Code *

Primary Email Address *

Primary Phone Number *

Secondary Phone Number *

Cabinda Heritage & Affiliation

Place of Origin in Cabinda (City, Village) *

Ancestral Link *

Are you already a member of another CCUSA chapter?

YesNo

Professional & Community Details

Current Profession / Occupation *

Name of Employer *

Additional Information

Have you been involved in community organizing?

YesNo

Languages Spoken (besides English and Portuguese) *

Declaration & Signature

I declare that the information provided above is true and accurate. I agree to abide by the constitution and by-laws of the Association of Cabinda Community in the United States of America.

Signature (type your full name) *

Date

Referred by *

Relationship to referrer *