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ONLINE MEMBERSHIP APPLICATION

The Liberian Community of Syracuse (LICOS) INC. In the Americas was founded in Syracuse, New York 2004 and is dedicated in promoting understanding and respect among its members through Education, projects and other programs. We encourage you to join us and add your name, point of view and support to LICOS. Please feel free to fill out an application today and become a part of our Community!

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Name

First Name *

Last Name *

Gender *

Address

Address *

Apartment number

City/Town *

State *

Postal/Zip Code *

Phone *

Alternate number

Email Address

Contact Information

Are you 18 years old or older? * YesNo

What is your birth month? *

Name of child under age 18

Do you have a spouse? *

If yes, name of spouse

Father name

Mother name

Are you attending school now *

If yes, name of school

Your level of education *

If other, name

What is you interest *

Your home county *

Your country of origin *

More informations

If you have any comment, please state here

I apply to be a full member of LICOS. I understand that if selected to be a member, I share the ownership of this Community as well as the responsibilities for its prosperity and survival both legally and financially. I am therefore prepared to support its goals, objectives and abide by its constitution and bylaws as long as these remain consistent with the rules of law of the United States of America. Have you read and agreed to the term of use? * Yes

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