Membership Application Form

Name *

First Name Last Name

Middle or Maiden Name (optional)

Middle Name Maiden Name

Address *

Street Address

Street Address Line 2

City & County State

Zip Code

E-mail *

Phone Number *

Area Code Phone Number

Occupation *

Employer & Title *

Application Date

Month Day Year

Membership Type

Adult Membership ( $ 51.99 for each year )

Ages 27 and above Upon membership approval and paid dues, and in good standing may; Vote, Hold Office, Serve on Committees, and exercise all other rights and privileges granted an Adult Membership. Price includes $1.99 for processing fee.

Young Adult Membership ( $ 21.07 for each year )

You must be between the ages of 18 - 26, and be a resident of Cabarrus County. Price includes $1.07 for processing fee.

Student Membership ( $ 21.07 for each year )

You must be enrolled in high school and/or an institution of higher learning and be a resident of Cabarrus County. Please provide a copy of your current transcript. Price includes $1.07 for processing fee.

Honorary Membership ( $ 51.99 for each year )

This membership type is for non-residents of Cabarrus County. Upon membership approval and paid dues, and in good standing may; Attend meetings but cannot, Vote, Hold Office or Serve on Committees under an Honorary Membership Price includes $1.99 for processing fee

For Student Membership - Upload Transcript File Here

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Please select a committee(s) that you are interested in serving. *

Black Political Caucus of Cabarrus County Membership Application