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!T-Shirt Size(Required) Small Medium Large XL XXL XXXL 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: ____/____/____
