NHHCF

Membership Application Form

* Name

* Mobile

* Phone (LandLine)

* Phone(Work)

* FAX

* Email

* P.O Box

* Postal Code

* Country

* City

* Address

Tick the boxes to identify the type of donation

Active Member : A member who has the right to attend meetings and participate in activities.

Affiliated Member : A member who has the right to attend the foundation's activities.

Knight Member : A member who is under 21 has the right to participate in the foundation's activities.

Membership Fees Payment

CASH

CHEQUE

TRANSFER

Amount :

If you want to pay a Cheque, please make it to the NATIONAL HOME HEALTH CARE FOUNDATION- WESTERN REGION or deposit it to the account No 2810700001 of THE SAMBA FINANCIAL GROUP No of (IBAN) the current account at SAMBA, which is used in case of transfer funds from any internal or external bank to the current of the foundation in SAMBA (SA0840000000002810700001)

For more information please contact the coordinator of resource development programs:

Phone +96612257842 EXT 114

Fax +966126976051