The Collective Black People Movement (QAKOA) Membership Application
Your Queens and Kings of Afrika Dues are insured by our Ancestors, so there is never any past dues owed by any
member of the Queens & Kings of Afrika. If you don’t have money you may become a member of the Queens & Kings of Afrika and have
full membership benefits and privileges by completing the Membership Application.
Click Here to download the Queens & Kings Membership Application
Send completed Membership Application to
If you have any problems in becoming a member online please call 616 (315-5672)
All Membership with the Queens and Kings of Afrika is 50 Cents each day…
Collective Black People Movement Membership Application Please complete the following information. When completed, send to: firstname.lastname@example.org 1. Name: _________ , ___________ , _______ first last nickname male female 2. Mailing Address: _________________________________________________________ street number street apartment number _________________________________________________________________________________________ City state zip Country 3. Phone Number: __________________________ / __________________ Cell Home 4. Email Address: ________________________Web Site: _________________________ 5. Birthday: ______________________ Place of Birth: ________________ Month/Date/Year City/Country 6. How did you hear about the Collective Black People Movement? ___________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 7. What special skills do you have that can benefit our people? ______________________ _______________________________________________________________________ ________________________________________________________________________________________ 8. Education: List your High School, Trade School. College, University, and Military Experience Below along with the location and the subject(s) studied. Name of School (H.S., Trade, College, Univ.) City & State Years Subject Studied Attended 9. Work Experience: List the areas of work that you are capable of doing for your people: a. __________ b.___________ c. __________ 10. Do you have a Business? Yes/no. If yes, list it (them) below, so that we can advertise your business to the members of the QAKOA. Please submit a business card and/or Flyer with application. Name Type Location Address City State 11. Type of Membership: a. Circle the type of Membership you are interested in with the Collective Black People Movement. b. Circle how you would like to pay your membership (by the day, week, month, etc.) 12 a. Circle the areas of the Skills, Talents, and Intelligence that you would like to be involved with the QAKOA. b. Put a Star next to the departments you would like to be a coordinator for the QAKOA. All Departments Elder Council Physical Fitness Activist/Rallies/Letter Writing Emergency Preparedness Political Administration Employment Promotions Arts & Crafts Engineering Reggae Artist/Graphic Design Farming/Produce Reparations Automotive Filming & Recording Repatriations Brothers Union Fundraising Research Business Operations Health & Nutrition Safety Child Care Hip Hop Sister Union Collective Record Company History Special Events Computers Housing & Shelter Spirituality Construction Incarceration Sports Correspondence Insurance Technology Culture Law Transportation Dance/Theatre Media United Front Dating/Relationship Medical Youths Union Documentation Membership Other: __ Education Operations/Management Other: __ 13. As a member of the Collective Black People Movement, I will be righteous in all dealings with the members of the Collective Black People Movement and our people. ______________ ________________ ____ Print Name Signature date ———————————————————————————————————————————————– Please keep a record of your QAKOA membership due contributions. # of People Day Week Month 3 Months 6 Months Year Individual — 27 Cents $1.89 $8.10 $24.30 $48.60 $97.20 Student — 27 Cents $1.89 $8.10 $24.30 $48.60 $97.20 Elder — 27 Cents $1.89 $8.10 $24.30 $48.60
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