CCA Application Form

Application for
membership with the
Corporate Council on Africa

Please fill out this form and click the "SUBMIT" button when finished.
Your dues for membership to CCA will be $3000.

Name of Organization:
Address:
City:	State:	Zip Code:
Chairman's Name:
President's Name:
CEO's Name (if not one of the above):

The following individual is designated as the contact person:

Name:
Title:
Company:
Mailing Address:
City:	State:	Zip Code:
Phone:	Fax:
Email address:
Web site address:

Tell us a little about yourself and your orginization.
Include your reasons for becoming a CCA Member.

Thank You for applying for membership with the Corporate Council on Africa.

Your membership dues will be $3000. Click on the SUBMIT button to be given a choice to pay now (by credit card), or by mail.

The Corporate Council on Africa has enabled a secure server that allows for information to be sent via the Internet in a secure manner. The CCA's secure server takes advantage of the latest encryption technologies which require the latest versions of Netscape 4.0+ or Internet Explorer 4.5+.