Mr.     Mrs.     Ms.    Miss     Other           *Date:  01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

*First Name:            M.I.            *Last Name:    

*Address:    Apt #:     Suite #: 

*City:    *State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   *Zip:    *Phone No: 

Email Address:         *Registered Voter?  Yes     No

*Do you wish to affiliate with your local NAACP Unit?  Yes  No 

Unit name or number (if known) 

New Member   Renewal Membership        If renewal, member ID #       Gift Membership

Regular Adult  (Ages 21 & Older) . . . . . . . . . . . . . . . . . . $30*

Youth with Crisis Magazine (Ages 20 & under) . . . . . . . .$15*

Youth without Crisis Magazine (Ages 17 & under) . . . . . $10*

Annual Corporate . . . . . . . . . . . . . . . . . . . . . . . . . . $5,000*

WIN (Women In The NAACP) Membership . . . . . . . . . . .$10            
       Only available to current members

* Includes a 1-year subscription to The CRISIS Magazine

** Fully-paid Life Memberships include a 10-year subscription to The CRISIS Magazine

$6.00 per year of the membership fee will be applied toward your subscription to The CRISIS

 

 

Junior Life (Payable in annual installment of $25 or more) . . . . .  $100*    (Ages 13 & under)                    Date of Birth

Bronze Life (Payable in annual installed of $50 or more) . . . . . .  $400**  (Ages 14-20)                     Date of Birth

Silver Life (Payable in annual installed of $75 or more) . . . . . . . .$750**

Gold Life (Payable in annual installed of $150 or more) . . . . . . $1,500**  
             Only available to Silver or Regular Life Members

Diamond Life (Payable in annual installed of $250 or more) . . . $2,500**  
             Only available to Gold or Golden Heritage Life Members

Other Life Membership  (please specify)