REDHAC

Membership form

TO JOIN REDHAC, PLEASE COMPLETE THE SECURE MEMBERSHIP FORM

All information is sent through our secure and encrypted channel (SSL).

    Designation of the association and/or individual *
    Company name*
    Name and surname of the representative *
    Quality*
    Phone*
    Email *
    Brief presentation of the association and/or individual (objective, mission, aims, Activities)

    Other :

    .

    Name and first names of a member if this is the case
    Phone
    Reason for joining

    .

    (To be retained by REDHAC)

     

    I the undersigned *
    Receipt Number:
    Or not deliver
    CNI number for simple member
    A t
    The

    Residing at

    Done and signed at
    The

     

    (To be kept by the member)

     

    I the undersigned *
    Receipt Number :
    Or not deliver
    CNI number for simple member

    A t
    The

    Residing at
    Email *
    Done and signed at
    The

     

    (*) Required fileds

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    Douala - Cameroon, 17 Street 1108 Bali, behind Total Njo-Njo, 1st Villa Brown Portal,
    (+237) 697 618 195 / 681 238 996
    executive director@redhac1.org

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