Registration form for CDS Balimaya activities 3

Registration form for CDS Balimaya solidarity fund

Title

First Name

Last Name

man/ woman

Man Woman

Age

Number of people

Address

Province

City

Zip Code

Home Phone

Cell Phone

I declare that I wish to become a member of the CDS Balimya community fund

I declare that I wish to become a member of the CDS Balimya community fund As such, I acknowledge having read the membership conditions and pay the annual fee of $200.00.

Message

Registration form for CDS Balimaya solidarity fund

Contact Detail

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