BAP Application

BAP Application

Your success begins with our relationships
Name*

First NameLast Name
Spouse/Partner Name

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Spouse/Partner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
VOTING CITY/STATE*
City/State
Spouse/Partner VOTING CITY/STATE
City/State
VOTING ZIP CODE*
Spouse/Partner VOTING ZIP CODE
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse/Partner Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email 1:*
example@example.com
Spouse/Partner Email 2:
example@example.com
ABOUT YOU
Your Date of Birth*

MonthDayYear
DOB
Are you an American Black (AB)? (proof maybe required)*

YesNo
Is/Was your Mother an American Black? (proof maybe required)*

YesNo
Is/Was your Father an American Black? (proof maybe required)*

YesNo
Is/Was your Grand Mother or Great Grandmother an American Black? (proof maybe required)

YesNo
Is/Was your Grand Father or Great Grand Father an American Black? (proof maybe required)

YesNo
Your Voter Status (Mark all that apply)*

I am a registered VoterI can register but have notI am not allowed to Vote (proof will be required)
With BAP financial support and endorsement would you be interested in running for any of the following office (check all that apply)*

School BoardCity and County OfficesState OfficesFederal Offices
I want to help young American black kids with? (mark all that apply)

School and Educational ProgramsCoaching and Sports Programs
Do you understand what passive income mean?*

YesNo
By signing the BAP Pledge I agree and understand that I will be using my vote to elect BAP candidates and advance BAP agenda*

Yes - I agreeNo
By signing the BAP Pledge I agree and understand that when possible I will support and buy black products and services*

Yes - I agreeNo
By signing the BAP Pledge I understand and agree to follow BAP policies, rules, and guidelines*

Yes - I agreeNo
About SPOUSE/PARTNER
Spouse/Partner Date of Birth

MonthDayYear
DOB
Spouse/Partner is American Black (AB)? Fill out below to join else If SPOUSE/Partner NOT joining mark SINGLE*

YesNoSingle
Is your Spouse/Partner American Black (AB)? *

YesNo
Is/Was your Spouse/Partner Mother an American Black? (proof maybe required)

YesNo
Is/Was your Spouse/Partner Father an American Black? (proof maybe required)

YesNo
Is/Was your Spouse/Partner Grand Mother or Great Grand Mother an AB? (proof maybe required)

YesNo
Is/Was your Spouse/Partner Grand Father or Great Grand Father an AB? (proof maybe required)

YesNo
Spouse/Partner Voter Status (Mark all that apply)*

I am a registered VoterI can register but have notI am not allowed to Vote (proof will be required)No Spouse/Partner (mark if no Partner joining)
With BAP financial support and endorsement would you be interested in running for any of the following office (check all that apply)

School BoardCity and County OfficesState OfficesFederal Offices
I want to help young American black kids with? (mark all that apply)

School and Educational ProgramsCoaching and Sports Programs
Do you understand what passive income mean?

YesNo
By signing the BAP Pledge I agree and understand that I will be using my vote to elect BAP candidates and advance BAP agenda

Yes - I agreeNo
By signing the BAP Pledge I agree and understand that when possible I will support and buy black products and services

Yes - I agreeNo
By signing the BAP Pledge I understand and agree to follow BAP policies, rules, and guidelines

Yes - I agreeNo
GENERAL QUESTIONS
What restaurant or business not in your city*
you would like to HAVE
Do you belong to the Black Chamber of Commerce*

YesNo
Do you know at least 2 people who you think would benefit from this passive income investment program?
Name and Phone Number*

NamePhone#
Name and Phone Number

NamePhone#
Signature*
Spouse/Partner Signature
The Black and Proud (BAP) Investment Club (IC) is a private organization. The BAP IC reserves the absolute right, in its sole discretion, to deny any application for membership or to terminate the membership of any individual at any time, without obligation to provide reason or justification, and without recourse by the applicant or Member. All applicants and Members acknowledge and agree that information, discussions, strategies, and materials relating to the Investment Club, its Members, and its activities are strictly confidential and shall not be disclosed to any third party without the prior written consent of the BAP IC. Furthermore, All applicants and Members agree not to make, publish, or communicate any statement, whether oral or written, that could reasonably be construed to disparage, discredit, or otherwise harm the reputation or interests of the BAP IC, its members, or Managers/ Sponsors.
Should be Empty:

BAP Application

ABOUT YOU

About SPOUSE/PARTNER

GENERAL QUESTIONS

Do you know at least 2 people who you think would benefit from this passive income investment program?