Application for Membership

By virtue of your visit to this site you are demonstrating interest in Haiti and its' culture. Why not join us, at NOAH, in championing the cause of Haiti? For pennies a day, you, too, could make a difference. Thank you for your interest in Haiti! Our membership form is attached.

  Please check one:
Corporate - Lifetime $10,000   Corporate - Annual $2,500
Nonprofit - Lifetime $5,000   Nonprofit - Annual $500
Individual - Lifetime $2,000   Professional - Annual $250
Individual - Annual $75   Friend - Annual $25
Student - Annual $10      
  Please fill in your contact information:
First name: Last name:    
Address:
City: State:    Zip:
Phone: Fax:    
Professional Affiliation:
Other Haitian Group Affiliations:
Comments:

Committee Membership:

Yes, I want to assist NOAH in "Restoring democracy for Haitians in the Unithed States and Abroad," and "Rebuilding Haiti for a Brighter Tomorrow" by volunteering my services. I wish to serve on the following committees:

Immigration Health and welfare Fund Development
Legal Education Newsletter
Research Grassroots Other
Membership    

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1400 East West Highway Suite G, Silver Spring, MD 20910
Tel: 1-800-355-0204 Fax: 301-585-5395
NOAH e-mail: jbaptiste@noahhaiti.org
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