Carolina Black Caucus Membership Form

Name*

First NameLast Name

Gender

Phone Number

Please enter a valid phone number.

Email *

Title*

Department/Unit/Organization*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Membership Status*

JoiningRenewing

Please select the most appropriate membership type. Please note that each membership will be charged a $2.00 transaction fee. This is included in the membership cost.*

UNC Faculty

Faculty who are currently employed at the University of North Carolina at Chapel and are committed to supporting and furthering the mission and vision of the Carolina Black Caucus.

$32.00

UNC Staff/Administrator

UNC staff/administrators who are currently employed at the University of North Carolina at Chapel and are committed to supporting and furthering the mission and vision of the Carolina Black Caucus.

$32.00

Graduate Student/Professional/Post-Docs

Graduate/Professional/ students who are currently enrolled at the University of North Carolina at Chapel and are committed to supporting and promoting the mission and vision of the Carolina Black Caucus. The membership type is also open to Post Docs conducting research and training at the University.

$22.00

Alumni (non-UNC employees)

UNC alumni who are not employed by the University who are committed to supporting and furthering the mission and vision of the Carolina Black Caucus

$22.00

Facilities/Housekeeping Staff

The Caucus offers free membership to Carolina's housekeeping and facilities staff.

$ Free

Friends of the Caucus-(Non-voting membership)

Any individual affiliated or unaffiliated with the university who has a vested interest in supporting and promoting the mission and vision of CBC.

$42.00

Total

$0.00

Would you like join a subcommittee? If so, please select committee(s) below.

Please let us know what you desire to gain from and/or what you hope to accomplish as an active member of the Carolina Black Caucus.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.