Membership Registration Form

Note: All memberships run on a calendar year basis from

January 1 to December 31

Mailing Address:Alaska Black Caucus, P.O. Box 200048, Anchorage, AK 99520
Alaska Black Caucus Annual Membership Application -ADULT

-- Minimum age for ADULT application is 18 -- Any individual who agrees to uphold the principles and policies of the Alaska Black Caucus may become a member with the consent of the Board of Directors. Membership requires acceptance of the Constitution and Bylaws of the Alaska Black Caucus in writing, along with the payment of the annual membership fee(s) as determined by the Board of Directors.
Personal Information
Membership Type
New or Renewal?
Name*

PrefixFirst NameLast NameSuffix
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Birthday (Month and Day only (e.g. May 24):
Month Born: blanks* . Date Born: blank* .
Phone Number:*

Area CodePhone Number
Thank you for your interest in becoming a member of the Alaska Black Caucus! Your support helps us continue our mission of advocating for Black Alaskans and other marginalized groups.
Profession / Occupation
Are you a registered voter?*

YesNo
Which of these committees are you most interested in participating or learning more.

HealthJusticeEducationEconomicsPolitical ActionYouthYoung Adult (18+)
Membership Options*
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Annual Membership$100.00
The Alaska Black Caucus is a 501(c)(3) non-profit organization. Effective January 1, 2025, the membership fee will be $100 per calendar year.
By clicking the "Submit Application" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.

Thank you!

Alaska Black Caucus

P.O. Box 200048

Anchorage, AK 99520
Should be Empty:

Alaska Black Caucus Annual Membership Application -ADULT