(This form can be printed. Once you have completed the information, please mail it with your check or money order to the Monroe County Branch NAACP address listed below.)

MONROE COUNTY BRANCH NAACP MEMBERSHIP FORM "Join The Fight For Freedom" Please Print Date:

____________________

Mr. / Mrs. / Ms.:

________________________________________

Street Address:

________________________________________

City, State Zip:

________________________________________

Branch Affiliation:

________________________________________

Current Membership Number (renewal): ________________________________________

Regular Annual Membership

Lifetime Membership

[ ] Regular Adult

$30

[ ] Junior Life $100 (birthdate __________)

[ ] Youth with Crisis

$15

[ ] Bronze Life $400 (birthdate __________)

[ ] Youth without Crisis $10

[ ] Silver Life

$750

[ ] Annual Corporate

[ ] Gold Life

$1,500

[ ] Diamond Life

$2,500

$5,000

Check Number: __________

Amount: __________

MAILING INFORMATION PLEASE MAKE CHECKS PAYABLE TO NAACP Thank you for your support. Membership Monroe County Branch NAACP P.O. Box 243 Bloomington, IN 47402-0243 Please save a copy of this completed form as your receipt.

monroe county branch naacp membership form

Diamond Life. $2,500. Check Number: ______. Amount: ______. MAILING INFORMATION. PLEASE MAKE CHECKS PAYABLE TO NAACP. Thank you for your support. Membership. Monroe County Branch NAACP. P.O. Box 243. Bloomington, IN 47402-0243. Please save a copy of this completed form as your receipt.

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