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MEMBERSHIP APPLICATION FORM

Name:*

Surnameyour full name
First Nameyour full name

Passport:*

Passport / ID Numberyour full name
Provinceyour full name
Countryyour full name
Regionyour full name
Gender
Residence status
Languageyour full name
Residential Addressyour full name
Postal Codeyour full name
Professionyour full name
Telephone (W)your full name
Telephone (H)your full name
E-mailyour full name
Cellphoneyour full name

Next Of Kinyour full name
Relationshipyour full name
Countryyour full name
Contact Noyour full name
Addressyour full name

DEPOSIT DETAILS

Account Name: Sam Soya Center for Democracy and Human Rights

Account Number: 62762629908

Bank Name: First National Bank (FNB)

DECLARATION

I solemnly declare that I will abide by the aims and objectives of the SSCDHR & SCAEF as set out in the Constitution, the Freedom Charter and other duly adopted policy positions, that I am joining the organisation voluntarily and without motives of material advantage or personal gain, that I agree to respect the Constitution and the structures and to work as a loyal member of the organisation, that I will place my energies and skills at the disposal of the organisation and carry out tasks given to me, that I will work towards making the SSCDHR & SCAEF an even more effective instrument of liberation in the hands of the people, and that I will defend the unity and integrity of the organisation and its principles, and combat any tendency towards disruption and factionalism.

  •  I am 18 years or over.
  • All information supplied is true and correct.
  • If any of the information supplied is incorrect or misleading or if I do anything deemed not to be in the interests ofSSCDHR & SCAEF and my membership can be terminated.
  • By signing this document I agree to abide by the conditions of membership laid out in the Constitution.
  • I pledge active participation in all activities and will contribute positively wherever I may be called upon to do so.
  • I will participate in human rights awareness campaigns and meetings when required to. Where I cannot attend Iwill formally notify SSCDHR-SCAEF in ample time.
  • SCAEF recommend South African R100 (China ¥ 100), Europe€10, UK£10, USA$15) monthly membershiplevy (payments methods: bank deposits/ transfer, PayPal/ credit cards / pay points and payable monthly, ininstallments or once off, depending on personal choice) for immigration, legal and many other covers for allAmbazonians or Southern Cameroonian registered as Exiles under SSCDHR.
  • Upon registration and payment of the first monthly levy (R100) you will be eligible to have SSCDHR—SCAEF Card and enjoy lots of benefits of being a members of SSCDHR.
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