St. Petersburg Branch of ASALH, Inc New and Renewal Membership

Membership Information Form

For New Members and Renewals
ASALH requires membership at both National Level and Branch Level. Before completing this Branch form, please CLICK HERE to join the National ASALH Organization.

Individual Branch Membership (Annual Dues: $50)

Dual Branch Membership (Annual Dues: $100)

Institutional (Business/Nonprofits Annual Dues: $250)

___________________________________________________________
Name of Primary Member*

First NameLast Name
Email address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Which Branch Level Membership Are You Choosing?*

Individual at $50 AnnuallyDual at $100 Annually (2 in Same Household)Institutional at $250 Annually
How Will You Pay Branch Dues?*

Zelle my dues to asalhstpete@gmail.com (Our Zelle Name is St Petersburg Branch of ASALH, Inc)Mailing a Check To ASALH St Petersburg
IF CHOOSING A BRANCH DUAL MEMBERSHIP: What is the Name of the 2nd Person? (Type NA if this section does not apply)*
Which National Level Membership Did You Choose?*

General MembershipSenior 65+StudentLifeJunior LifeDual Household of 2 SeniorsLife InterimInstitutional
What is Your National Membership or Legacy Number? *
PLEASE COMPLETE THIS SECTION ONLY IF YOU CHOOSE A BRANCH INSTITUTIONAL MEMBERSHIP
NAME OF YOUR ORGANIZATION/BUSINESS
Website
Primary contact name
Primary contact email
example@example.com
Your Position There
Organization/Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization/Business Phone Number
Please enter a valid phone number.
Duration of membership

The ASALH Membership Year is January 1 to December 31.

Dues paid after the Annual Conference will be applied to the next calendar year.

Dues are NOT prorated.
ZELLE YOUR PAYMENT TO

asalhstpete@gmail.com

MAIL YOUR CHECK OR MONEY ORDER PAYMENT TO THE BRANCH

ST. PETERSBURG BRANCH OF ASALH, INC

PO BOX 35504

ST. PETERSBURG, FL 33705
Should be Empty:

Membership Information Form