Join the Fight for Freedom

National Association for the Advancement of Colored People

Membership is the life-blood of the NAACP. We depend on our
members’ generosity to insure the NAACP’s independence.
We depend on you to keep the flames of freedom bright.

MEMBER INFORMATION
Mr. ___ Mrs. ___ Ms. ___ Miss ___ Other ____________________ Date ___________________

____________________________________________________________________________________
First Name Middle Initial Last Name

____________________________________________________________________________________
Address

____________________________________________________________________________________
City, State, ZIP

___________________________ ______________________________________________________
Phone Number Email Address

3002 Carbondale, IL New ___ Renewal ___ ___________________________________

Unit Affiliation Current Membership Number if Renewal

Are you a registered Voter Yes ___ No ___

MEMBER TYPE
REGULAR ANNUAL MEMBERSHIP
___ Regular Adult (Ages 21 and older) - - - - - - - - - - - - - - - - -$30.00
___ Youth with Crisis Magazine (Ages 20 and under) - - - - - -$15.00
___ Youth without Crisis Magazine (Ages 17 and under) - - - $10.00
LIFETIME MEMBERSHIP
___ Junior Life (Ages 13 and under) - - - - - - - - - - - - - - - - - - $100.00
___ Bronze Life (Ages 14 - 20) - - - - - - - - - - - - - - - - - - - - - - -$400.00
___ Silver Life (Ages 20 and older) - - - - - - - - - - - - - - - - - - - -$750.00

PAYMENT INFORMATION
Amount Paid $_____________ Check # __________ Cash _____
MasterCard ___ Visa ___ American Express ___ Discover ___
Card Number ______________________________________________ Expiration Date ___________
Name on Card _________________________________ Signature _____________________________

THANK YOU FOR YOUR SUPPORT

Mail to:
NAACP - P. O. Box 3303 - Carbondale, IL 62902