Membership Application Form

Black Political Caucus of Cabarrus County Membership Application

Applicants must be of African Diaspora to apply for membership. Please complete all questions. The Black Political Caucus reserves the right to accept or reject any membership application. In the event, your membership is rejected, you will be refunded the full amount. ***Once you click "Apply for Membership" button. Submit payments to ( paypal.me/BPCCabarrus ). Membership: $27.99. Thank you!
Name*

First NameLast Name
Middle or Maiden Name (optional)

Middle NameMaiden Name
Address*

Street Address

Street Address Line 2

City & CountyState

Zip Code
E-mail*
Phone Number*

Area CodePhone Number
Occupation *
Employer & Title*
Application Date

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

Budget and FinanceMembershipCommunity AffairsEducationPolitical ActionVoters Registration /Get Out the VoteNot interested
Membership Type

Adult Membership: $26.99($25 + $1.99 fee)Young Adult Membership: FreeStudent Membership: Free
For Student Membership - Upload Transcript or photo of student ID
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Black Political Caucus of Cabarrus County Membership Application