Affuadusa, Inc.

NB: All Starred fields are mandatory!

Username*

Password*

Note: password should contain; numbers and letters. Minimum password length > 8 characters!

Password confirmation*

Note: password should contain; numbers and letters. Minimum password length > 8 characters!

Show Password

Family name*

Provided Referral

First name*

Middle name

Last name*

Phone Number

Country Of Origin*

Country Of Residence*

Street*

City

Zipcode

Note: Please ensure that you use the Dob Calendar and you do not input the Dob directly!

Date Of Birth*

Optional: ID Card/Driver's License

Card Front

Card Back

Optional: Beneficiary

First Name

Middle Name

Last Name

Phone Number

Do you agree to abide by our Bylaws?

Registration Details

Number of Members: 1

Registration Fee Per Member: $20.00

Administrative Fee Per Member: $10.00

Total Cost: $30.00