|
Date:___________________ |
BRANCH _____ |
|
Mr./Mrs. Ms:____________________________________________ |
Phone Number: _____________ |
|
Street Address:__________________________________________ |
|
| City:
______________________________________ __
State: _____________
Zip:___________ |
| E-mail:
___________________________________________ |
| |
| New
Membership_________ Current Membership No. (if renewal)____________ |
| Would you like
us to send you a voter registration form? [ ] Yes [ ] No |
|
, |
|
|
Regular Annual
Membership |
Lifetime Membership |
| Regular Adult
with Crisis $30 [ ] |
Junior Life- (date of birth_______)
$100 [ ] |
| Youth with
Crisis
. $15 [ ] |
Bronze Life- (date of birth_______)
. $400 [ ] |
| Youth without
Crisis
$10 [ ] |
Silver Life
..
.$750 [ ] |
| Annual
Corporate
$5,000 [ ] |
Gold Life
.
$1,500 [ ] |
| |
Diamond Life
.
.
$2,500 [ ] |
| . |
| Method of
Payment: Check [ ] Check Number [ ] Cash [ ] Do Not
Mail CASH |
| |
|
|
MAILING INFORMATION |
|
Please make checks payable to NAACP. and mail to: |
|
Membership Department
National Association for the Advancement of Colored People
PO Box 2439 Leesburg, VA 20177 |
|
Thank you for your support.
|
|
OUR GENERAL MEETINGS ARE THE 3RD MONDAYs of
each month at 7:30pm, in the basement of the First Mount Olive Baptist Church,
216 Loudoun St. SW, Leesburg.
Call our office 703-779-2990 or visit our website at
www.naacploudoun.org for further information |
