NAACP Membership Application

"Join The Fight For Freedom"

Date ________

Please Print

Mr./Mrs./Ms._____________________________ Telephone No. ____________

Street Address ____________________________________________________

City _________________________ State__________ Zip_________________

Branch Affiliation _________Virginia Beach - #7124

Date of Birth ___________ Current Membership No. (if renewal) _________

Please make checks payable to NAACP

Regular Membership  Lifetime Membership
Regular Adult ................  $30.00 Junior Life ........... $100.00
Youth w/ Crisis............... $15.00 Bronze Life........... $400.00
Youth w/o Crisis............. $10.00 Silver Life.............. $750.00
Annual Corporate............ $5,000.00 Gold Life............... $1,500.00
Diamond Life........ $2,500.00

Check Number: ___________

Contact:  757-490-7799

Please print a copy of this application for your records.  Mail to:

NAACP
4805 Mt. Hope Drive
Baltimore, MD 21215-3297