NAACP MEMBERSHIP APPLICATION
To apply for membership please complete all questions. Unit #5822
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which committees would you like to be a part of?
Health & Education Committee
Programming Committee
Membership Committee
Political Action Committee
Royal Court Committee
Press and Publicity Committee
If you would like to be on the Press & Publicity Committee, please upload an example of your work here:
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My Products
*
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One Year NAACP Youth & College Membership
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
T-shirt (optional)
$10.00
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Shirt Size
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Billing Address
Use the address above.
I want to specify a different billing address.
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Proof of Payment (Please Attach a Screenshot of Proof of Payment Via Paypal)
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GroupMe Link
https://groupme.com/join_group/116985684/TyiceRbH
Payment Methods
Choose from one of the PayPal options to
make your payment.
Apply for Membership
Apply for Membership
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