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Membership Registration for Worldwide Family of Lebanon

Card Information

Please fill the following information required for your Membership Card

Last Name:*

First Name:*

Date of Birth:*

Gender:*

Marital Status:*

Father Last Name:*

Father First Name:*

Show on Card

Mother Last Name:*

Mother First Name:*

Nationality:

Country of Origin:*

City / Village of Origin:*

Lebanese Ascendancy:*

Photo:

Contact Information

Please indicate that the following Contact Information will be the same as your Billing Address

Last Name:*

First Name:*

Address:*

Country:*

City:*

Zip Code:

Telephone 1:*

Telephone 2:

E-mail:*

Delivery Address

The below Address will be the Address that we will send the Membership Card to

Same as Contact Information

Last Name:*

First Name:*

Address:*

Country:*

City:*

Zip Code:

Telephone 1:*

Telephone 2:

Work Information

The below information are necessary to make your profile included in our Online Directory which members can see your name, e-mail, city, country and your profession

Profession:

Description:

(max. 250 chars.)

Associations

Association:

Interest Information

Interest:

Description:

(max. 250 chars.)

Languages

Language:

Payment Options

Registration in the Directory is free. However, by paying 30 US$ per year, your Membership Card will be printed and delivered to you by post. You will then have the right to publish the link of your website or blog for one year. If you wish to pay more, the difference will serve as a donation.

Free

$30

Password

Password:*

(min. 6 chars.)

Confirm Password:*

Notes:

(max. 250 chars.)

How did you know about us?*

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I have read RJLiban Terms and Conditions *

* Required