Copyright © 2006 The Wisconsin Mandingo Association of Milwaukee ( WIMAM ) Inc. All rights reserved.

WIMAM MEMBERSHIP INFORMATION FORM
FIRST NAME:
MI:
 LAST NAME:
DATE OF BIRTH:
YOUR ADDRESS:
APARTMENT:
CITY:
 STATE:
ZIP CODE:
CELL PHONE:
HOME  PHONE :
 FAX NUMBER:
NATIONALITY:
YOUR EMAIL ADDRESS:
NOTE: ALL FIELDS ARE REQUIRED
PLEASE MAIL YOUR MEMBERSHIP FEE OF $20.00 (TWENTY DOLLARS ) AT WIMAM,INC,
P.O. BOX 080185, MILWAUKEE, WISCONSIN 53208.  MAKE CHECK OR MONEY ORDER
PAYABLE TO WIMAM.

I, THE UNDERSIGNED APPLICANT, DO HEREBY CERTIFY THAT ALL INFORMATION GIVEN
ABOVE IS TRUE AND CORRECT.
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