National Black Deaf Advocates, Inc.

www.nbda.org

REGULAR MEMBER
INDIVIDUAL MEMBERSHIP FORM
2015

REGULAR: $25.00

SENIOR CITIZEN (55+) $20.00

($15 NBDA, $10 Local BDA Chapter)

($10 NBDA, $10 Local BDA Chapter)

STUDENT $20.00
($10 NBDA, $10 Local BDA Chapter)

Regular Membership is a dual membership of both NBDA and Local BDA chapter.
To check if theres an active Local BDA Chapter in your area, visit www.nbda.org/local_chapters.
If you reside in an area that doesnt have a Local BDA Chapter, please use Member-At-Large Membership form.

Name of Local BDA Chapter (required):

Please check one (double click box to mark X):

New Member

Renewing Member

Please check one (double click box to mark X):

Regular

Senior Citizen

Student

Note: A copy of current school ID can be enclosed along with this form and payment.

MEMBER INFORMATION
Date:
Name:
Address:
City:

State:

Phone:

Voice

Zip Code:
VideoPhone

Text

Email Address:
MEMBERSHIP BENEFITS

Subscription to quarterly NBDA Connections publication

Discounts to regional and national conferences
Voting privileges during elections and general business meetings
The opportunity to run and serve on the Executive Board (must be a member for two consecutive years prior to election)

Opportunity to serve on national programs and committees

Discounts on NBDA merchandise and More!
ONLINE MEMBERSHIP PAYMENT & PAPERLESS

If you prefer to pay your membership dues online, please visit www.nbda.org and click on Become a Member.
After completing paying your membership dues online, please email this form to secretary@nbda.org.
NBDA eNEWS & DONATION

Want to receive news and announcements from NBDA? To subscribe NBDA eNews notifications, please visit
www.nbda.org, scroll down to the bottom and sign up your email address under Whats New.

If you would like to make a donation to NBDA, please visit www.nbda.org and click on Donate Now.

Mail this form with your payment to:

National Black Deaf Advocates, Inc
Membership
P.O. Box 564
Secane, PA 19018-0564
If you have any questions, please contact NBDA Secretary at secretary@nbda.org.

Thank you for supporting NBDA!

National Black Deaf Advocates, Inc. P.O. Box 502658, Indianapolis, IN 46250
The Mission of the National Black Deaf Advocates is to promote the leadership development, economic and educational opportunities,
social equality, and to safeguard the general health and welfare of Black deaf and hard of hearing people.