MODA Membership Application

Application For Membership

Apply for Membership with the Movement Of Displaced African (MODA)
To Offer Guidance And Assistance To The Descendants Of The Enslave In The Americas And The Caribbean For Social, Economic, Educational, And Self-Empowerment.
Full Name*

First NameLast Name
Birth Date

MonthDayYear
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Background & Connection to Displacement
Country of Origin/Heritage
How are you connected to the cause of displacement*
Your Story/ Motivation for joining (Optional)
Briefly share your story, your passion for this cause, or what you hope to achieve by joining MODA
Skills & How You Can Contribute

MODA is built by its members. Tell us how you can help the movement. (Select all that apply)
Other Skills or Areas of Contribution:
Graphic design, event planning, public speaking, etc.
Membership Commitment
MEMBERSHIP FEES:

$60.00 USD Annually$30.00 USD Semi-Annually
Membership Via Zelle

Name: Movement Of Displaced Africans Email: info@movementofdisplacedafricans.org
Type a question*

I have read and agree with the mission and value of MODA.I agree to abide by the organization's code of conduct, respect and inclusivity.
How did you hear about us?*
Signature*

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Application For Membership