AACS Membership Form
Please fill out the form to apply for membership in the African American Cultural Society and Museum
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Birth Month
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Birth Day
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Which Committee Would You Like To Help?
Ways & Means
Membership
The Scribe
Budget & Finance
African Studies
Cultural
Public Affairs
Youth Black History Reality Program
Type of membership
*
Individual $100 per year
Family Household $150 per year
Individual Young Adult (age 18 to 34) $50 Per Year
Submit
Should be Empty: