Asa Online Registration Form

Please provide the following contact information:

First Name

Last Name

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

Home Phone

E-mail

Website

Please identify and describe yourself:

Sex Male Female

Which country are you from?

Would you like to be put on our electronic mailing list ?

Yes No

In some situations, we may need to directly contact members, via telephone. Can an official of Asa call you should such a situation arise?

Yes No

Send email to bakinsan@gmu.edu if you have difficulties accessing this website.
Copyright � 1998 African Student Association
Author: Babatunde O. Akinsanya
Last modified: Saturday, February 06, 1999 12:05:40 PM

Asa Online Registration Form

Send email to bakinsan@gmu.edu if you have difficulties accessing this website. Copyright � 1998 African Student Association Author: Babatunde O. Akinsanya Last modified: Saturday, February 06, 1999 12:05:40 PM

Send email to bakinsan@gmu.edu if you have difficulties accessing this website.
Copyright � 1998 African Student Association
Author: Babatunde O. Akinsanya
Last modified: Saturday, February 06, 1999 12:05:40 PM