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National Council of Negro Women, Inc. (909) 874-6000 Membership Application Contributions are deductible for Income Tax Purposes! Bold fields are required on this form Membership Classification (Please check all that apply) New Renewing Life Legacy Application Date Name: Address: Address (cont): City: County: State / Province: Country: APO - FPO ARUBA APO AFRICA ALGERIA FPO ARGENTINA AUSTRALIA AUSTRIA BANGLADESH BELIZE BERMUDA BELGIUM BELARUS BOLIVIA BRUNI BRAZIL BULGARIA CAMBODIA CANADA CAYMAN ISLAND CHINA CHILE COLUMBIA CROATIA CYPRUS CZECH REBUBLIC DENMARK DOMINICAN REPUBLIC DUTCH WEST INDIES ECUADOR EGYPT EAST MALAYSIA ENGLAND ESTONIA FINLAND FRANCE FRENCH GUYANA FRENCH ANTILLIES GHANA GREAT BRITAIN GREENLAND GREECE GERMANY GUAM GUADELOUPE GUYANA HONG KONG HOLLAND HUNGARY ICELAND INDIA INDONESIA IRELAND ISRAEL ITALY JALISCO JAMAICA JAPAN KOREA KUWAIT LATVIA LITHUANIA LUXEMBOURG MACUA MARIANA ISLANDS MALAYSIA MARTINIQUE MALTA MANITOBA MEXICO MONACO NETHERLANDS ANTILLIES NEW BRUNSWICK NEW CALDONIA NETHERLANDS NEWFOUNDLAND NEW GUINEA NORTHERN IRELAND NORWAY NEW ZEALAND OMAN PAKISTAN PRINCE EDWARD ISLE PHILIPPINES POLAND PORTUGAL PUERTO RICO PERU REUNION ISLAND REPUBLIC OF YEMAN ROMANIA RUSSIA SOUTH AFRICA SAUDI ARABIA SCOTLAND SINGAPORE SASKATCHEWAN SLOVENIA SPAIN SOUTH PACIFIC SWEDEN SWITZERLAND TAIWAN THAILAND TURKEY UNITED ARAB EMIRATES USA UKRAINE UNITED KINGDOM URAGUAY VENEZUELA VIRGIN ISLANDS WEST AFRICA WALES WEST GERMANY YUGOSLAVIA Zip / Postal Code: Date of Birth Phone: Phone 2: Fax: Email: Type of Membership Payment Annual $41.00 (Includes National $25.00 and Local $16.00) Fully Paid Life Member $16.00 (Local only) Associate 25.00 (Local dues for men) Student $10.00 (Local dues for youth under 18) Life Member $500.00 (Four installments of $125.00) Organization Life Member: affiliate non-profit Church Comments:
National Council of Negro Women, Inc.
(909) 874-6000
Membership Application
Contributions are deductible for Income Tax Purposes!
New Renewing Life Legacy
Annual $41.00 (Includes National $25.00 and Local $16.00) Fully Paid Life Member $16.00 (Local only) Associate 25.00 (Local dues for men) Student $10.00 (Local dues for youth under 18) Life Member $500.00 (Four installments of $125.00) Organization Life Member: affiliate non-profit Church