Membership Registration Form

Website designed by Robert Sayon Morris 763-533-1952

Organization of

Liberians

in Minnesota

Date:

Last Name

First Name

Address

City/State

Zip Code

E-mail

Home Phone

Cell Phone

Dues $5.00 a month

*Amount Paid:

Signature

Thank you!

5701 Shingle Creek Parkway, Suite 650

Brooklyn Center, MN 55430

Tel: (763) 560-0031

*Click here to pay online using your Debit or Credit Card

if you have not already paid your dues.

You have the option to fill out the application form online or copy it, fill it out and mail it to the address below