I am donating (insert amount) up to $9,999.00 to the goal of "Reparations in my lifetime!"
MY TOTAL OF $ amount* represents One Membership, and may include a Donation. I understand I cannot apply for multiple persons using this form. The NCOBRA Membership Commission reviews applications, and I can expect a response within 30 days. Dues will be returned if an application is not accepted, or applied as a Donation if I so authorize. My group/organization will receive additional communication from the National Office and/or a Regional Representative. (To apply AS AN INDIVIDUAL if you are separately representing a group, please submit a different application.)
NCOBRA Membership, 1006 Surrey St., Lafayette, LA 70501, (202) 643-1460 (vm), firstname.lastname@example.org