Membership Application First Name(Required)Last Name(Required)Email(Required) Best phone number(Required)Type of phone?(Required) Cell Landline Date of Birth(Required) MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code ANNUAL MEMBERSHIPS Annual Renewal ($30) New Member Annual Membership ($30) Youth Annual | Adults 20 & Under with CRISIS ($15) Youth Annual | Adults 20 & Under without CRISIS ($10) Annual Corporate Membership ($5,000) LIFETIME MEMBERSHIPS Junior Life | Ages 13 & Under ($100) Annual Payment $25 Bronze Life | Ages 14-20 ($400) Annual Payment $50 Silver Life ($750) Annual Payment $75 Gold Life ($1,500) Annual Payment $150 Diamond Life ($2,500) Available to Gold or Golden Heritage Life Members. For information on Golden Heritage LIfetime Membership, please contact our branch!Volunteer CommitteesPlease check yes for all the committees you are interested in. Afro-Academic, Cultural, Technical, and Scientific Olympics (ACT-SO) Armed Services and Veterans’ Affairs Communications, Press & Publicity Community Coordination Criminal Justice Economic Development Education Environmental & Climate Justice Finance Freedom Fund Health Committes Labor & Industry LGBTQIA+ Legal Redress Membership & Life Membership Political Action Prison Branch Religious Affairs Young Adult Youth Works Women in the NAACP (WIN) Tell Us More!Agreement & SignatureDate(Required) MM slash DD slash YYYY By adding my name and the date, I affirm that ...Name(Required) First Last OFFICE USE ONLYPayment Received: Amount $ _____________ Membership Card: ____/____/____ Added to Membership Portal: ____/____/____
