Membership Application Form

Henry-Clayton Section National Council of Negro Women Membership Application

Helping Communities Thrive in the Midst of Adversity
Website

www.henryclaytonncnw.org
Zelle

financecommhenryclaytonncnw@gmail.com
Mailing Address

PO Box 414 Stockbridge, GA 30281
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Home Number
Cellular Number*
Date Joined*

MonthDayYear
Date
Birthday*
Month and Day
Professional Expertise*
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Which committee(s) would you like to serve on?*

Economic Empowerment and EntrepreneurshipSTEAM (Education)Health EquitySocial JusticeMembershipBy-LawsOutreachHospitalityWays and MeansMedia/TechnologyYouth Committee
Membership Type*
prevnext( X )
National MembershipSection Fees: $75.00+ National Fees $75.00
$150.00



Associate (Supporting) Men
$75.00



Youth Membership Section $20 and National $10
$30.00



Life Membership (Regular or Associate)Can be paid in 4 $250 installments.
$1,000.00



Legacy Life MembershipCan be paid in 4 $375 installments
$1,500.00
Questions

If you have any questions about membership please email membership.hcncnw@gmail.com. If you have any questions regarding dues submission, please email fsncnw@gmail.com and cc financecommhenryclaytonncnw@gmail.com
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Henry-Clayton Section National Council of Negro Women Membership Application