ENROLL | combass

ENROLLMENT

Payment Options

1. Bank of America Account# 446045123823

Routing# 052001633

2. Zelle: ComBASS Phone# 240-564-8257

3. CashApp: 240-564-8257 or Cashtag: $ComBASS

4. PayPal: ComBASS Website: combass.org

(Add 2.9%) PayPal Fee

5. Credit Card: ComBASS Website

Please include all names with each payment and send a text or screenshot to ComBASS 240-564-8257

COMMUNITY BEREAVEMENT AND SICKNESS SUPPORT (ComBASS) Fraternity

Member Application

! STOP

Please read the article of association/by-laws online before you proceed to fill out this application

Combass Enrollment Form

Enrollment is open to everyone

First name

Last name

Age

Month

Day

Year

For 65+ add sponsor info below

Multi-line address

Country/Region

Address

City

Zip / Postal code

Email

Phone

Sponsor for 65+

Sponsor Full Name

Sponsor Age

Month

Day

Year

Sponsor Address

Country/Region

Address

City

Zip / Postal code

Sponsor Email

Sponsor Phone

(IN THE EVENT OF THE PASSING OF A MEMBER, PLEASE PROVIDE BENEFICIARY INFORMATION)

Beneficiary's Full Name

The information I have provided in this application is true, complete, and accurate to the best of my knowledge and belief and is provided in good faith. I understand that providing a false statement on this application may result in my disqualification as a member of ComBASS.

I have read and agreed to the terms of the article of association.

Contact us 14001C Saint Germain Dr. Suite 431 Centreville, VA 20121

info@combassusa.com Tel: 240-564-8257 Fax: 240-560-8257

Fixed price

$45

Call us today for enrollment 240-564-8257 or enrolled online

ENROLLMENT

Payment Options

Combass Enrollment Form

Enrollment is open to everyone

Sponsor for 65+

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