Membership form

Category: Uncategorised Published: Thursday, 25 August 2016 Written by Super User

 

 

የጤና፣ ልማትና ፀረ ወባ ማኅበር የአባልነት ቅጽ

 

Health, Development & Anti Malaria Association Membership Form

 

 

1.  ስም/Nameግለሰብ/Individual/ቤተስብ/ Family/የድርጅት/Organization _____________________________________________________

 

2.  አድራሻ/Address

 

2.1.  ከተማ/City or Town: __________________________________________

 

2.2.   ክ/ከ/Sub city: ______________________________________________

 

2.3.  የቤት ቁጥር/House No: ________________________________________

 

2.4.   ስልክ/Phone: _______________________________________________

 

2.5.   ኢሜል/Email: ______________________________________________

 

3.  የአባልነት ዐይነት፡

 

3.1.    መደበኛ/Regular        

 

3.2.    ተባባሪ ግለሰብ /Associate        

 

3.3.    ተባባሪ ቤተሰብ/Family       

 

3.4.    ተባባሪ የተቌም/Organization

 

4.  የክፍያ መጠን/Payment amount: _____________________________________

 

5.  የክፈያ ጊዜ/Payment time: __________________________________________

 

6.  ስምና ፊርማ/Name and Signature: __________________________________

 

7.  ቀን/Day: _______________________________________________________

 

8.  አድራሻ፡ የባንክ ሂሳብ ቁጥር፡ 1000001842882 (የኢትዮጵያ ንግድ ባንክ)

 

ኢሜል፡ This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it.

 

ስልክ፡ +251 11 157 5455 ረ +251 11 157 5422

 

9.  የጤልፀወማ ተጠሪ አሰተያዬት/HDAMA Focal Person Remarks: ______________________________________________________________________________________________________________________________

 

የአባልነት አይነትና ክፍያ በዓመት / Membership Types and  Annual Membership Fee Amounts/

መደበኛ አባል /regular member/…………………………..   ብር 12 እና በላይ / Birr 12 and above /

ተባባሪ  ግለሰብ አባል/ Associate individual/………………  ብር 300 እና በላይ/ Birr 300 and above/

ተባባሪ የቤተስብ አባል /Associate Family/………………….  ብር 500 እና በላይ / Birr 500 and Above/

ተባባሪ የድርጅት አባል/ Associate Organization/ ……………ብር 1000 እና በላይ / Birr 1000 and Above/

 

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