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Coptic Solidarity Membership Application

Kindly fill the electronic form here below. If you prefer to use a paper-form, please print the below form, fill it out and mail to Coptic Solidarity or hand to one of its representatives.

Application Form

Your identity and information provided herein are strictly confidential and will not be revealed to any persons or organizations without your permission

Name *

Age *

Address *

ZIP Code *

Country *

Phone (Home)

Phone (Office)

Phone (Cell)

Email *

Confirm Email *

Profession *

Education Degree *

Community Service Experience
Please check all that apply *

A brief description / history *

Recommended by / Reference Contact *

Accept Terms (Summary Charter) *

Type of membership *

Please fill in this text

Notes :

- Please pay Membership fees using the online "Donate" option, or by check addressed to: Coptic Solidarity, P.O. Box 1450 Centreville, VA 20122, USA.

- You will be notified of the acceptance within 30 days of your application. In the eventual case it is denied, your fees will be reimbursed in full.

- An appropriate IRS receipt will be sent to U.S. residents in time for the annual tax filing.

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